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CONSUMPTION  CURABLE 


AND  THE  MANNER  IN  WHICH 

NATURE  AS  WELL  AS  REMEDIAL  ART 

OPERATES  IN  EFFECTING 

A HEALING  PROCESS  IN  CASES  OF  CONSUMPTION; 


EXPLAINED  AND  ILLUSTRATED  BY 


NUMEROUS  REMARKABLE  AND  INTERESTING  CASES  : 


TO  WHICH  IS  ADDED 

A MODE  OF  TREATMENT, 


BY  WHICH 

THE  DEVELOPMENT  OF  TUBERCLES  MAY  BE  PREVENTED 
IN  PERSONS  LIABLE  THERETO, 

FROM  HEREDITARY  PREDISPOSITION,  OR  A BAD  STATE  OF  THE  SYSTEM 
INDUCED  BY  VARIOUS  CAUSES. 


“ Laguerison  dans  les  cas  de  phthisie  pulmonaire  ou  I’organe  n’a  pas  6te  entierement 
envahi,  ne  presente,  ce  me  semble,  aucun  caractere  d’impossibilite,  ni  sous  le  rapport  de 
la  nature  du  mal,  ni  sous  celui  de  I’organe  affecte.” — Laennec,  Nouv.  Ed.,  tom.  ii,  p.  112. 


BY 

FRANCIS  HOPKINS  RAMADGE,  M.  D. 

FELLOW  OF  THE  ROYAL  COLLEGE  OF  PHYSICIANS,  SENIOR  PHYSICIAN  TO  THE  INFIRMARY  FOR 
ASTHMA,  CONSUMPTION,  AND  OTHER  DISEASES  OF  THE  CHEST,  ETC.,  LONDON. 


FIRST  AMERICAN  FROM  THE  THIRD  LONDON  EDITION. 

WITH  AN  INTRODUCTION  BY  THE  PUBLISHER, 

•IN  WHICH  SEVERAL  CASES  ARE  STATED  WHERE  THIS  PRACTICE  HAS  PROVED  SUCCESSFUL  IK 
THIS  COUNTRY,  WITH  OTHER  CORROBORATIVE  TESTIMONY. 


N E W-Y  0 R K : 

PUBLISHED  BY  J.  M.  HOWE,  102  GRAND-STREET, 

AND  TO  BE  HAD  ALSO  OF 

WILEY  & PUTNAM,  161  BROADWAY. 


1839. 


O’  This  Book,  together  with  the  Tube,  may  be  had  of  J.  M.  Howe,  Dentist,  at 
No.  102  Grand-street,  New-York.  Mr.  Howe  will,  also,  give  directions  as  to  the 
use  of  the  Tube,  and  any  other  information  in  his  power  connected  with  this  subject. 
All  letters  must  be  post  paid. 


“ Entered  according  to  Act  of  Congress,  in  the  year  1839,  by  J.  M.  Howe,  in  the 
Clerk’s  Office  of  the  District  Court  of  the  Southern  District  of  New-York*” 


Rm-c 

INTRODUCTION. 


y In  presenting  the  work  of  Dr.  Ramadge  to  the  American  public,  it 
it  may  be  proper  to  give  some  explanation  as  to  the  circumstances 
which  have  led  to  its  publication.  The  following  letter,  which  appeared 
sS>  in  the  Christian  Advocate  and  Journal,  of  March  1,  1839,  will  throw 
^ some  light  upon  the  subject. 

LETTER  TO  CONSUMPTIVES. 

Messrs.  Editors, — A two-fold  object  induces  me  to  present  the  fol- 
lowing  for  publication  ; the  one  to  proclaim  the  goodness  of  God  in 
his  providential  dealings  with  me  in  staying  the  hand  of  disease  and 
death,  and  the  other  the  very  novel  instrumentality  by  which  it  has 
been  effected  ; hoping,  by  the  blessing  of  God,  it  may  be  a means  of 
saving  some  similarly  afflicted.  And  without  entering  into  any  detail 
of  the  general  state  of  my  health,  I would  remark  that  I took  a cold 
in  December,  1837,  after  attempting  to  preach,  which  settled  in  my 
throat,  and  finally  terminated  in  chronic  bronchitis  ; and  after  having 
had  the  best  medical  advice  at  home  for  about  four  months  without 
any  benefit,  but  rapidly  getting  worse,  so  that  my  throat  and  lungs 
were  considerably  affected,  and  my  voice  reduced  to  a whisper,  every 
change  of  weather  affecting  me  much,  I was  informed  by  my  medical 
friends  that  I had  nothing  to  expect  from  medicine,  and  that  a sea 
voyage  and  change  of  climate  would  be  the  only  possible  means  of 
alleviating  my  symptoms.  In  June  last  I sailed  for  Liverpool.  The 
result  of  the  voyage  was  entire  physical  prostration  ; but  I still  hoped 
that  change  of  climate  would  perform  for  me  what  the  voyage  had 
not.  For  this  purpose  I travelled  to  some  extent  in  England,  and 
consulted  three  of  the  most  eminent  physicians,  who  recommended 
similar  means  to  those  of  the  physicians  at  home.  These  remedies 
gave  no  relief,  but  together  with  the  humidity  and  changeableness  of 
the  climate  and  the  fatigue  of  travelling,  rather  aggravated  my  di- 
sease. I then  went  into  France,  hoping  for  the  time  being  my  symp- 
toms would  be  alleviated ; but  was  again  disappointed.  And  being 
wearied  out,  and  despairing  of  any  relief  from  the  ordinary  means 
used  in  such  cases,  I committed  myself  entirely  to  the  Lord  ; being  in 
much  doubt  whether  my  health  would  enable  me  to  reach  my  home. 
At  Boulogne,  on  my  return,  I was  obliged  to  consult  another  physi- 
cian ; but  to  no  purpose.  And  when  I returned  to  London,  I seemed 
literally  choking  to  death,  and  had  to  take  to  my  room  and  bed.  In 
this  condition  I was  providentially  relieved  by  a work  being  put  into 


c 


4 


INTRODUCTION. 


my  hands,  entitled  “ Consumption  Curable,”  by  Dr.  Ramadge,  the  se- 
nior physician  of  the  London  Lung  Hospital.  After  a cursory  read- 
ing of  the  book,  I was  led  to  consult  the  doctor,  and  was  by  him 
encouraged  to  expect  entire  recovery.  He  directed  as  a principal 
means — medicine  being  only  auxiliary — a tube  to  breathe  through.  I 
followed  his  advice,  and  experienced  by  its  use,  in  the  course  of  only 
one  or  two  days,  very  essential  relief.  It  was  the  first  thing  I 
had  found  to  alleviate  my  symptoms  in  the  least.  It  is  now  five 
months  since  I began  to  use  the  tube,  and  my  recovery  has  been  gra- 
dually progressing.  On  the  first  of  January  last,  I resumed  my  labours  as 
chaplain  of  the  City  Hospital,  from  which  I had  been  laid  aside  for 
nearly  one  year ; and  what  is  very  remarkable,  and  speaks  volumes 
for  the  tube,  though  I arrived  in  the  city  in  October  last,  with  the 
most  unfavourable  season  before  me,  and  have  exposed  myself  to  all 
weathers,  (storms  not  excepted,)  and  have  twice  taken  severe  colds 
which  settled  in  my  bones,  I have  not  once  had  any  cold  to  settle  on 
my  lungs  or  in  the  throat ; although  previous  to  my  using  the  tube, 
the  slightest  unfavourable  change  affected  me  most  seriously. 

The  tubes  are  made  of  different  materials,  and  are  five  feet  long^ 
and  half  an  inch  in  diameter,  furnished  with  a mouth-piece,  and  piece 
to  contract  the  end  to  keep  the  air  from  rushing  in  and  out  too  rapidly. 
The  instrument  is  to  be  used  three  times  a day  for  the  space  of  from 
four  to  six  months,  discontinuing  its  use  under  certain  symptoms. 

I would  further  remark  that  Dr.  Ramadge  is  a regularly  educated 
physician,  and  has  been  for  nearly  twenty  years  in  the  London  Lung 
Infirmary,  and  for  several  years  past  the  senior  physician.  This  is  a 
public  institution,  and  has  been  established,  if  I mistake  not,  about 
one  hundred  years,  and  is  under  the  patronage  of  the  nobility  and 
gentry  of  England.  He  assured  me  again  and  again  that  the  use  of 
the  tube  would  do  more  to  prevent  consumption,  and  restore  those  who 
are  consumptive,  than  any  other  means  within  his  knowledge. 

The  doctor  has  written  a very  able  work  on  the  subject,  explaining 
the  philosophy  of  his  treatment,  in  which  he  shows  the  great  benefit 
arising  from  inhalation  in  preventing  consumption,  by  enlarging  the 
volume  of  the  lungs,  and  materially  altering  the  shape  of  the  chest ; 
and  also  curing  the  disease  in  its  incipient  stages,  and  even  after  the 
top  of  both  lungs  has  been  very  considerably  ulcerated. 

So  very  limited  is  the  knowledge  of  Dr.  Ramadge’s  work  on  the 
treatment  of  throat  complaints  and  consumption  in  this  country,  al- 
though on  the  continent  of  Europe  it  has  been  translated  into  several 
languages,  and  so  invaluable,  in  my  humble  opinion — for  I am  quite 
sure,  under  God,  I owe  my  life  to  him — that  I consider  it  an  im- 
perative duty  I owe  to  my  suffering  fellow-men  to  call  their  atten- 
tion  to  it. 


INTRODUCTION. 


5 


While  in  London  I was  several  times  at  the  Hospital,  and  conversed 
with  many  of  the  patients,  who  all  testified  to  the  benefit  of  the  tube ; 
and  since  my  return  home  I have  recommended  it  to  several,  some  of 
whom  have  found  very  great  benefit.  I shall  be  happy  to  show  the 
tube,  and  also  to  furnish  such  other  information  as  to  the  manner  of 
using  it,  together  with  some  general  information  on  the  subject,  at  my 
dwelling,  No.  102  Grand-street,  New-York. 

JOHN  M.  HOWE. 

The  preceding  letter  was  extensively  copied  in  the  city  and 
country  papers,  and  was  read  with  so  much  interest,  being  so  novel 
in  its  character,  that  many  persons  called  on  me  soliciting  further  in- 
formation, and  many  from  abroad  wrote  to  me  ; as  answering  them 
consumed  much  of  my  time,  and  subjected  me  to  some  expense,  and 
being  desirous  to  spread  the  information,  and  to  do  it  more  effectually, 
I abridged  Hr.  Ramadge’s  work,  and  published  a thousand  copies  ; and 
although  it  is  but  six  months  since  its  publication,  without  the  aid  of 
notices  from  the  press,  the  whole  are  nearly  disposed  of.  It  now 
appears  necessary  that  another  edition  should  be  printed  ; and  so  re- 
peatedly has  the  work  been  called  for  by  physicians  and  others,  that 
all  doubt  is  now  dispelled  as  to  the  publication  of  the  complete  work 
being  sustained. 

As  the  principles  of  practice  laid  down  in  this  work  differ  very  ma- 
terially from  those  of  practitioners  of  our  own  country  in  chest  dis- 
eases, and  as  I have  been  successfully  treated  by  the  doctor,  to  whom, 
under  God,  I am  indebted  for  the  prolonging  of  my  life,  (a  debt  of  gra- 
titude I can  never  repay,)  for  the  benefit  of  others  I deem  it  incum- 
bent upon  me  to  state  a few  facts  corroborative  of  this  practice,  drawn 
from  my  own  case,  and  facts  obtained  from  others. 

For  several  years  past  I had  suffered  much  from  indigestion,  which 
deranged  the  whole  system,  and  produced,  finally,  disease  in  the  lungs. 
Previous  to  sailing  for  England  my  symptoms  were,  the  hectic  fever, 
night  sweats,  cold  chills,  a slight  hacking  cough,  with  some  expecto- 
ration  5 voice  reduced  to  a whisper,  and  much  emaciation  of  body.  I 
was  labouring  under  most  of  these  symptoms  when  I came  under 
.the  care  of  Dr.  R.  I was  informed  that  both  my  lungs  were  tuber- 
culous, and  had  long  considered  my  case  utterly  hopeless,  unless  God  in- 
terposed in  some  extraordinary  way  to  save  me.  Almost  the  first 
question  that  I proposed  to  Dr.  R.  was,  with  my  mouth  to  his  ear,  in 
a whisper,  “ Doctor,  can  I yet  live,  or  must  I die?”  He  replied,  “You 
have  come  just  in  time  to  save  your  life  ; you  will  recover.”  “ Shall 
I have  my  voice  ? shall  I be  able  to  speak  loud  ? shall  I be  able  to  sing  ? 
shall  I be  able  to  preach  ?”  To  all  of  which  he  answered,  “ You  will 
certainly  recover  your  voice  so  as  to  speak  loud,  to  sing,  and  to  preach.” 


6 


INTRODUCTION. 


“ How  long,  sir,  will  it  probably  be  ere  this  takes  place  ?”  He  re- 
plied, In  four  or  six  months  you  will  call  yourself  quite  well,  and  you 
will  attain  a vigour  you  have  not  had  for  years.”  I replied,  “ Ah, 
sir,  I am  afraid  to  rely  upon  you.”  He  answered,  with  warmth,  “ I 
would  ensure  it  by  my  right  arm,  were  it  possible.”  I then  informed 
him  that  I had  made  arrangements  to  leave  England  in  twenty  days, 
and  inquired,  whether  he  wished  me  to  tarry  longer.  He  replied,  “ You 
may  return  by  that  time.’’  Upon  subsequent  interviews  with  him,  I 
made  particular  inquiries  relative  to  my  future  place  of  residence,  &c. 
He  directed  me  to  pass  the  winter  at  home,  and  not  to  change  for  a 
warmer  climate,  which  I had  previously  purposed  to  do,  and,  instead 
of  confining  myself  to  a warm  room,  or  to  the  house,  to  expose  my- 
self to  the  weather  every  day,  without  regard  to  storms,  as  occasion 
might  require.  Being  somewhat  skeptical  as  to  the  propriety  of  the 
advice  given,  with  the  doctor’s  permission  and  invitation,  I visited 
several  times  the  lung  infirmary,*  to  get  what  information  I could 
from  persons  under  his  care, — to  many  of  whom  I proposed  the  follow- 
ing questions  : “ What  is  the  nature  of  your  disease  ?”  “ Consump- 

tion,’’ was  the  usual  reply.  “ Whose  care  have  you  been  under  pre- 
vious to  coming  here  for  advice  ?”  Some  answered  one,  and  some, 
another  ; some  named  one  or  two  hospitals.  “ Did  you  get  benefitted 
“ No.”  “ How  long  have  you  been  here  ?”  They  answered  different 


* It  may  be  of  importance  to  state,  for  the  information  of  those  who  are  unac. 
quainted  with  the  standing  of  Dr.  Ramadge,  and  the  institution  with  which  he  is 
connected,  that  he  is  a regularly  educated  physician,  and,  for  nearly  twenty  years 
last  past,  has  been  physician  to  the  London  Lung  Infirmary.  Through  the  kind- 
ness of  a friend,  I am  enabled  to  give  the  following  statement,  copied  from  the 
Royal  Calendar,  and  Court  and  City  Register,  for  England,  Scotland,  Ireland,  and 
the  Colonies,  for  the  year  1825. 

“ Infirmary  for  Asthma,  Consumption,  and  other  Diseases  of  the  Lungs,  Union- 
stjeet,  Bishopsgate. 

President,  Duke  of  Sussex. 

Vice  Presidents,  Marquis  of  Camden,  Marquis  of  Cholmondeley,  Earl  of  Darn- 
ley,  Earl  of  Crawford,  Lord  Calthorpe,  Bishop  of  Salisbury,  Benjamin  Shaw,  Esq., 
Thomas  C.  Marsh,  Esq.,  John  Meyer,  M.  D. 

Treasurer,  William  Heygate,  Esq. 

Consulting  Physician,  Isaac  Buxton,  M.  D. 

Physician,  F.  H.  Ramadge,  M.  D. 

Apothee  and  Surgeon,  Mr.  Hurkey. 

Honorary  Secretary,  Samuel  Amory,  Esq. 

Assistant  Secretary  and  Collector,  Mr.  William  Eddrup,  White-chapel  Road. 

Housekeeper,  Mrs.  Elizabeth  Fuller.” 

From  the  above,  it  appears  that  Dr.  R.,  as  long  ago  as  1825,  was  physician  to  the 
institution,  and  that  the  Infirmary  was  sustained  by  some  of  the  most  distinguished 
men  in  the  kingdom — and  I am  enabled  to  state,  from  my  own  personal  knowledge, 
that  the  institution  is  still  sustained  by  individuals  of  the  highest  rank,  and  that 
Dr.  R.  is  now,  and  has  been  for  several  years  past,  the  senior  physician. 


INTRODUCTION. 


7 


lengths  of  time.  “ Have  you  got  benefit  here?”  “I  have,”  was  the 
usual  reply.  “ Under  whose  care  are  you  in  this  place  ?”  “ Dr.  Ra- 

madge’s.”  “Do  you  consider  Dr.  Ramadge  a skilful  physician?” 
“ I do,  most  certainly.”  One  replied,  “ Sir,  you  could  not  have  your 
life  in  safer  hands.” 

I also  was  favoured,  upon  more  than  one  occasion,  by  being  present 
at  the  examination  of  some  thirty,  or  perhaps  fifty  persons,  who 
applied  for  advice.  One  instance,  which  made  a lasting  impression 
on  my  mind,  was  that  of  a young  woman,  of  very  interesting  appearance, 
dressed  in  deep  mourning.  After  an  examination  of  her  chest  and 
symptoms  she  inquired  his  opinion.  With  great  kindness,  and  sym- 
pathy of  feeling,  he  informed  her,  that  all  means  would  avail  but  little  ,* 
that  in  all  human  probability  she  would  not  recover.  The  silent  tear 
trickled  down  her  face  ; it  seemed  as  though  her  only  hope  was  cut  off. 
But,  added  he,  you  must  use  the  means,  and  try.  This  frankness  and 
plainness  of  dealing  inspired  me  with  much  confidence.  How  much 
better,  thought  I,  for  a physician  to  be  honest ; to  deal  plainly  with 
his  patients.  Why  should  a patient,  labouring  under  a fatal  disease, 
be  deceived  upon  a subject  of  so  much  importance.  How  much  better 
would  it  be  to  discover  to  him,  with  sympathy  and  kindness,  his  real  situ- 
ation, and  thus  afford  him  time  to  adjust  his  temporal  affairs,  and  make 
some  preparation  for  his  entrance  upon  the  untried  realities  of  another 
world,  than  to  keep  him  in  suspense,  or  in  the  expectation  of  recovery, 
until  the  last  moments  of  life. 

The  home-bound  voyage  was  much  more  comfortably  made  than 
the  outward  one.  I did  not  suffer  the  one-tenth  part  by  sea-sickness, 
owing,  in  part,  to  using  the  tube  for  a few  minutes  daily  in  the 
cabin,  which  produced  favourable  results  upon  the  stomach,  &c.,  by 
increasing  the  action  of  the  diaphragm. 

It  is  now  a year  since  I first  came  under  Dr.  R.’s  care,  and  I have 
realized  the  benefit  of  his  advice,  and  the  fulfilment  of  his  predictions. 
My  voice  has  returned  so  that  I can  sing,  for  a short  time,  at  its  highest 
pitch,  and  speak  loud  in  public  for  half  an  hour,  without  injury.  My 
digestion  is  better  than  it  has  been  for  years,  so  that  I am  enabled  to 
eat  whatever  is  set  before  me,  with  the  exception  of  hot  breads,  &c. 
But  what  is  of  still  greater  importance  is,  that  the  shape  of  my  chest 
is  very  astonishingly  improved  and  enlarged.  About  six  years  since 
the  measurement  of  my  chest,  close  under  the  arms,  was  thirty-two 
inches ; but,  for  five  years  following,  there  was  a gradual  diminution, 
so  that  for  three  years  previous  to  my  getting  the  tube,  my  mea- 
surement was  thirty  inches ; making  a decrease  in  the  size  of  two 
inches.  Since  getting  the  tube  I have  increased  in  size  two  and  a half 
inches,  making  my  measurement  now  thirty-two  and  a half  inches. 
But  the  alteration  in  the  conformation  of  my  chest  is  truly  wonderful. 


8 


INTRODUCTION. 


The  collar  bones  were  very  prominent,  and  the  pit  of  the  neck  so 
sunken,  and  the  chest  so  drawn  together,  that  I was  afraid  to  see  my- 
self in  the  glass.  Now  my  chest  has  recovered  a rounder  and  plumper 
appearance,  and  my  neck  has  filled  out,  so  that  the  conformation  is 
better  than  it  has  been  for  years ; and  my  whole  system  is  generally 
improved  ; the  principal  cause  of  which  I attribute  to  the  instructions 
received  from  Dr.  R. 

I would  also  remark,  that  previous  to  my  getting  the  tube  every  change 
of  weather,  even  the  slightest,  affected  me  much,  notwithstanding  the 
extra  clothing  put  on,  and  care  as  to  exposure ; but  since  using  the 
tube,  I have  taken  off  all  extra  clothing,  without  even  wearing  flan- 
nels, except  in  the  winter,  exposing  myself  to  all  weathers  every 
day  through  the  whole  of  the  last  winter ; and  up  to  the  present  time, 
(storms  not  excepted,)  without  once  taking  cold  in  my  lungs.  So 
great  has  been  the  benefit  received  that  I am  encouraged  to  expect  a 
much  greater  strength  of  lungs  than  I have  had  for  years,  and  perfect 
recovery. 

It  has  however  been  remarked  by  some,  that  my  lungs  never 
could  have  been  tuberculous,  and  that  consumption  could  not  have 
been  fairly  seated,  or  I should  not  have  recovered.  This  I grant 
is  the  conclusion  to  which  one  must  arrive  from  all  the  theories 
and  practice  in  common  use.  As  to  my  lungs  being  diseased, 
and  of  their  being  tuberculous,  I could  name  several  highly  res- 
pectable physicians  of  this  city  who  would  testify  to  the  fact. 
Previous  to  my  going  abroad  four  physicians,  three  of  them  of  emi- 
nence, informed  me  that  my  right  lung  was  diseased,  and  that  no  me- 
dical means  could  reach  my  case,  and  recommended  me  a voyage  and 
travelling.  One  of  them,  after  my  sailing,  informed  some  of  my  friends 
that  I would  never  return.  And  when,  in  the  good  providence  of  God, 
I had  the  first  interview  with  Dr.  Ramadge,  after  an  examination  he 
informed  me  that  both  my  lungs  were  tuberculous,  but  that  I should 
certainly  recover.  I wrote  home  to  a friend  that  Dr.  R.  stated 
that  my  lungs  were  tuberculous ; this  friend  informed  one  of 
the  physicians.  He  replied,  “ I knew  his  lungs  were  tubercu- 
lous previous  to  his  leaving  home.”  And  since  my  return,  two 
other  distinguished  physicians  of  this  city,  who  had  heard  of  my  case, 
called  to  see  me,  requesting  an  examination  of  my  chest ; for,  said 
they,  there  is  much  that  passes  for  consumption  that  is  not.  I grati- 
fied them,  and  they  pronounced  both  lungs  tuberculed ; and  one 
remarked  that  the  upper  lobe  of  the  right  lung  had  passed  to  hepatiza- 
tion. The  other  informed  me  that  he  had  no  more  doubt  of  the  diseased 
state  of  the  right  lung  than  though  he  could  see  it.  Besides  the  opi- 
nions of  physicians,  my  symptoms  and  appearance  would  justify  the 
belief  that  I was  fair  lyin  consumption,  and  many  of  my  friends  were 


INTRODUCTION. 


9 


of  the  same  opinion.  Dr.  Aider,  the  Wesleyan  delegate  to  Canada, 
now  in  this  city,  with  whom  I had  the  pleasure  of  a few  short  inter- 
views in  London  and  in  Paris,  informed  me  this  day  that  he  considered 
me  so  much  indisposed  that  he  doubted  whether  I would  survive  the 
home  voyage. 

I should  not  be  thus  particular  on  this  point  was  I not  fully  aware 
that  some  have  asserted  since  my  great  improvement,  that  I never 
had  the  disease.  My  own  opinion  is,  but  for  the  tube  and  Dr.  R.  as 
the  means,  with  the  divine  blessing,  ere  this  the  work  of  life  had  been 
done,  and  I should  have  been  taken  to  my  rest. 

But  my  own  case  is  not  a solitary  one.  I have  the  testimony  of 
persons  of  standing  and  of  undoubted  authority  whom  I have  recom- 
mended to  use  similar  means.  As  an  evidence  of  the  great  benefit  of 
inhalation,  a respectable  physician  of  this  city  informed  me  that  one 
of  his  patients  had  increased  in  size  two  inches  and  a half  by  the  use 
of  the  tube,  in  about  two  months,  and  that  another  of  his  patients 
had  received  very  great  benefit ; he  has  recommended  more  than  a 
dozen  to  use  it,  some  for  the  preventing  and  others  for  the  cure  of 
disease. 

Dr.  Wm.  H.  Huggins,  of  West  Hartland,  Conn.,  writes  me  thus : 

I have  felt  much  interest  in  relation  to  the  success  of  Dr.  Ramadge’s 
treatment  in  cases  of  phthisis  pulmonalis,  or  pulmonary  consumption, 
— but  fearful  that  this  like  other  modes  of  treating  that  insidious  dis- 
ease  might  prove  fruitless,  I have  delayed  expressing  my  opinion  until 
confirmed  by  observation.  I am  ready  to  say,  that  the  practice  has 
more  than  answered  my  expectations.”  This  gentleman  has  experi- 
mented in  six  or  seven  cases. 

John  L.  Sullivan,  M.  D.,  of  New-Haven,  after  having  perused 
Dr.  R’s.  abridged  work,  wrote  me  thus,  in  a private  letter  : — “ Permit 
me  in  thus  commencing  my  acquaintance  with  you,  and  which  I 
shall  hope  to  do  personally  when  I first  come  to  New- York,  to  con- 
gratulate you  on  the  good  providence  of  God,  who  not  only  sent  you 
abroad  in  suffering  to  find  the  remedy,  but  made  you  the  instrument 
of  the  introduction  into  your  country  of  the  means  of  restoring  many 
to  health.  We  and  the  public  have  much  reason  to  be  thankful  to 
the  merciful  and  beneficent  Disposer  of  events  for  this  method. 

“ The  invention  is  philosophical  and  consistent.  The  discovery 
was  arrived  at  by  the  cautious  gradations  of  observation  and  experi- 
ment to  establish  its  principles,  and  it  claims  no  more  than  reason 
warrants.”  This  gentleman  has  fully  adopted  Dr.  R.’s  practice  of 
inhalation  in  connection  with  his  own,  and  has  published  a pamphlet 
recommending  it. 

The  Rev.  H.  G.  L , of  New-Haven,  writes  me  thus : — “ It 

gives  me  pleasure  to  say  that  my  wife  appears  to  be  receiving  much 

2 


10 


INTRODUCTION. 


benefit  from  the  use  of  your  tube.  I cannot  but  hope,  if  she  improves 
as  she  has  done,  she  will  soon  be  as  well  as  formerly.” 

The  Rev.  D.  B.  Randall,  a member  of  the  Methodist  Episcopal 
Annual  Conference,  in  Maine,  who  had  used  the  tube  about  six  or 
eight  weeks,  was  so  much  benefited  that  he  rose  in  the  Conference,  in 
the  presence  of  about  two  hundred  ministers,  to  express  his  gratitude 
to  God,  and  to  recommend  it  to  others.* 

The  Rev.  A.  D.  Merrill,  of  Providence,  Rhode  Island,  has  taken 
so  much  interest  in  spreading  the  information  that  he  has  sent  for  a 
dozen  and  half  of  the  tubes. 

The  Rev.  Ezra  Withey,  late  of  Maine,  has  written  me  a very  in- 
teresting  account  of  the  benefit  he  received  from  the  use  of  the 
tube,  after  having  been  afflicted  with  a pulmonary  disease  for  two 
years,  during  which  time  he  had  applied  to  various  physicians  of  repu- 
tation without  any  relief.  He  had  been  so  afflicted  by  the  changes 
of  the  weather  previous  to  using  the  tube,  that  he  was  obliged  for 
three  months  to  confine  himself  within  doors  ; but  even  then  he  was 
greatly  affected.  When  so  far  relieved  as  to  expose  himself  to  the 
air,  he  only  ventured  out  during  a few  hours  in  the  middle  of  the  day  • 
but  not  a fortnight  had  elapsed  from  the  time  he  got  the  tube  till  he 
w’as  enabled  to  go  out  mornings  and  evenings,  in  damp  and  rainy 
weather  as  well  as  in  the  dry  ; and  ere  he  left  the  city  I listened  to 
him  twice  from  the  sacred  desk,  preaching  with  much  energy  and 
clearness  of  voice.  He , soon  returned  to  New-London,  where  he  is 
preaching  the  gospel ; and  he  writes  me  that  some  of  his  friends  state 
that  his  “ voice  in  singing  is  better  than  ever.” 

The  Rev.  Mr.  Garrett,  of  Lower  Canada,  writes  me  thus  : — 

NeW‘Yorlc,  July  29,  1839. 

Dear  Sir, — Last  June  I arrived  in  this  city  from  Hatley,  Lower 
Canada.  For  several  months  previous  I was  incapable  of  discharging 
the  ordinary  duties  of  an  itinerant  ^ reacher,  in  consequence  of  a se- 
vere cold  I received  during  last  winter,  producing  almost  constant 
pain  in  my  chest,  from  right  to  left,  great  pain  and  difficulty  in  speak- 
ing, together  with  frequent  discharges  of  blood  from  my  mouth. 

I had  been  recommended  by  my  medical  friends  to  abstain  in  toto 
from  public  speaking,  and,  if  possible,  to  take  a sea  voyage. 

In  attending  to  these  directions,  I came  from  the  province  of  Lower 
Canada  to  this  city,  and,  shortly  after  my  arrival,  was  introduced  to 
you  by  the  kindness  of  my  friend,  Mr.  S.  Dando.  Having  carefully 
perused  your  pamphlet  entitled  “ Consumption  Curable,”  I determined 

* He  has  since  recommended  it  to  others,  and  writes  me  that  “ it  has  given 
general  satisfaction.” 


INTRODUCTION. 


11 


to  procure  a tube  from  you,  and  try  its  effects  upon  myself.  I com- 
menced by  regularly  breathing  backward  and  forward,  through  the 
tube,  according  to  your  directions,  and,  through  divine  mercy,  have, 
since  then,  been  constantly  increasing  in  inward  strength ; so  much 
so,  that  yesterday  I was  enabled  to  comply  with  an  invitation  from 
my  excellent  friend,  the  Rev.  Mr.  Trippet,  Wesleyan  minister  of  Se- 
venth-street chapel,  to  officiate  in  his  pulpit.  I can  now  breathe 
much  deeper,  and  with  less  pain,  than  formerly.  I have  also  had  but 
one  return  of  blood-spitting  since  I commenced  using  the  tube.  I find, 
after  an  exact  measurement  of  my  chest,  that  I have  gained  rather 
more  than  three  quarters  of  an  inch.  I still  continue  to  use  the  tube, 
and  confidently  hope  that  through  the  divine  blessing  I shall  be  fully 
restored  to  my  former  health  and  strength. 

You  are  (allow  me  to  say)  at  perfect  liberty  to  make  any  use  of  the 
above  simple  and  unvarnished  statement  of  facts  you  think  proper. 

I am,  dear  sir,  respectfully  yours,  &c., 

RICHARD  GARRETT. 

The  following  testimony,  from  the  pen  of  Rev.  Mr.  Sunderland,  is 
also  very  interesting : — 

New- York,  March  20,  1839. 

Dear  Sir, — It  is  now  three  months  since,  at  your  recommendation, 
I commenced  using  the  tube  invented  by  Dr.  Ramadge,  for  the  cure 
of  pulmonary  consumption.  As  you  know,  it  is  more  than  seven 
years  since  I lost  my  voice  from  a severe  bronchial  affection,  caused 
by  preaching  when  I had  a bad  cold.  During  this  time  I have  used 
every  means  in  my  power  for  a recovery  ; and  while  my  general  health 
for  two  years  past  has  been  very  good,  my  voice  had  recovered 
but  very  little  strength  ; (I  mean,  of  course,  strength  sufficient  to  ena- 
ble me  to  speak  in  public  ;)  till  since  I commenced  using  the  tube. 
And  though  I have  used  it  only  about  eight  weeks  in  all,  yet  I must 
say  that  the  tone  of  my  voice  has  improved  considerably  more  in  this 
time,  I think,  than  during  a number  of  years  before.  This  is  also  the 
opinion  of  my  friends.  And  it  seems  to  me  that  a slight  acquaintance 
with  the  anatomy  and  physiology  of  the  human  body  must  convince 
any  one  that  the  system  adopted  by  Dr.  Ramadge  is  based  upon  the 
immutable  principles  of  philosophy  and  truth  ; and  the  success  which 
has  crowned  his  practice  for  a number  of  years  puts  the  matter  beyond 
all  reasonable  doubt,  that  consumption,  if  attended  to  in  time,  can  be 
cured.  LE  ROY  SUNDERLAND. 

Mr.  Sunderland  has  since  informed  me  that  he  is  well. 


12 


INTRODUCTION. 


From  the  Rev.  T.  J.  Harris. 

Having  been  afflicted  for  a number  of  years  with  a most  inconve- 
nient and  distressing  affection  of  the  throat,  it  at  length  terminated 
in  the  raising  of  blood.  I was  induced  to  procure  of  Mr.  J.  M.  Howe 
the  tube  recommended  by  Dr.  Ramadge,  and  instructions  for  its  use, 
&:c.,  and  have  found  it  effectual  in  removing,  in  the  course  of  a few 
weeks,  entirely  the  inflammation  from  my  throat,  and  a most  distress- 
ing sense  of  pain  and  weakness  of  my  lungs.  Whereas  formerly  my 
pulpit  services  were  attended  with  great  pain  and  suffering,  I have 
now  for  some  time  resumed  them,  with  great  comfort  to  myself,  and 
with  little  pain  or  difficulty  of  any  kind,  and  am  free  to  say,  that  no- 
thing that  I have  ever  tried  has  had  the  effect  produced  by  the  tube. 

REV.  T.  J.  HARRIS, 

Pastor  of  2d  Mariners'  Church,  New-  York, 

From  Rev.  Mr.  Sutton,  of  New-  York. 

Dear  Sir, — I take  much  pleasure  in  informing  you  that  since  I 
commenced  the  use  of  Dr.  Ramadge’s  inhaling  tube  my  health  has 
slowly,  yet  constantly  improved  to  the  present  time.  When  I obtained 
the  tube  of  you  my  health  was  very  poor,  as  you  will  recollect,  and  my 
difficulty  in  breathing  was  very  great.  This  was  attended  with  inflam- 
mation of  the  left  lung,  and  an  almost  unceasing  pain  in  the  left  breast 
and  side.  These  symptoms,  however,  are  being  gradually  overcome, 
insomuch  that  I am  strongly  inclined  to  believe  that,  with  the  blessing 
of  a good  Providence,  a final  restoration  will  yet  take  place.  As  to 
the  propriety  of  the  tube  in  cases  of  bronchial  and  pulmonary  affec- 
tions I can  have  no  doubt ; faith  has  been  inspired  in  me  by  its  phi- 
losophy and  its  use.  Furthermore,  I have  obtained  the  tube  for  several 
intimate  friends,  to  whom  I recommended  it,  and  who  are  now  being 
benefited  by  it.  The  increase  in  the  size  of  my  chest  since  I first 
obtained  the  tube  has  been  two  inches. 

I am  most  affectionately  your  brother, 
New-York,  Sept.  4,  1839.  GEORGE  D.  SUTTON. 

A lady  of  wealth  and  respectability,  residing  in  Abingdon-square, 
whose  habit  is  decidedly  consumptive,  and  who  is  confined  to  her  house, 
under  the  care  of  a respectable  physician,  has  been  using  the  tube  by 
his  advice.  When  he  obtained  it  for  her  he  informed  me  that  her 
lungs  were  so  much  diseased,  particularly  one  of  them,  which  was  ex- 
tensively tuberculated,  that  he  had  no  expectation  that  she  could  live 
any  length  of  time,  being  very  much  debilitated,  with  great  weak- 
ness of  voice,  &c.  She  has  received  very  great  benefit,  so  as  to  enjoy 
comfortable  health.  In  order  to  obtain  some  facts  relative  to  her 


INTRODUCTION. 


13 


case  I visited  her  while  preparing  this,  and  she  informed  me  that  her 
chest  has  enlarged  two  or  three  inches  since  commencing  the  use  of 
the  tube,  that  her  voice  is  much  strengthened,  so  that  she  can 
converse  with  less  weariness  than  formerly,  and  can  indulge  in  sing- 
ing a little,  and  that  her  general  health  is  greatly  improved.  Her 
improvement  thus  far  affords  the  highest  gratification  to  her  friends. 

A lady,  in  whose  integrity  and  piety  I have  the  utmost  confidence, 
informed  me,  a few  days  since,  that  as  she  was  sailing  down  the  Hud- 
son, in  one  of  our  steamboats,  an  aged  lady  on  board  informed  her 
that  her  daughter  had  been  raised  from  a very  low  consumptive  state 
by  the  use  of  the  tube,  to  the  agreeable  disappointment  of  her  phy- 
sician and  family. 

From  William  H.  Huggins^  M.  Z>.,  of  West  Hartland,  Conn.,  dated 

Oct.  11,  1839. 

I wish  you  to  forward  another  tube,  book,  (fee.,  to  Hartford,  as  soon 
as  Friday,  the  18th,  without  fail.  I herewith  enclose  the  amount.  I 
have  several  patients  under  my  care  who  are  using  the  tube,  and  at 
present  seem  to  be  benefited  materially  by  it.  Yours,  &;c., 

WILLIAM  H.  HUGGINS. 

I have  many  interesting  communications : one  more  shall  suffice. 
A lady  from  Owego  writes  me  thus : — 

“ Before  I used  the  tube,  at  times  I could  not  speak  a loud  word, 
and  it  was  very  difficult  for  me  to  breathe ; but  after  using  it  about 
three  weeks,  I was  not  again  attacked  with  such  extreme  weakness  of 
voice  and  pressure  for  breath.”  She  adds,  “ I am  acquainted  with  two 
ladies  who  are  using  your  tubes,  and  have  received  great  benefit  from 
them.  One  resides  in  Newburgh,  and  the  other  in  Shawangunk.’’ 

So  increasingly  numerous  have  been  the  cases  of  pulmonary  con- 
sumption, and  so  fatal  the  progress  of  the  disease  throughout  a 
large  portion  of  our  widely  extended  country,  notwithstanding  all  the 
efforts  made  to  arrest  it,  that  if  more  information  can  be  thrown  on 
its  treatment,  it  is  due  to  the  public  that  it  should  be  communicated. 
And  while  intelligent  writers  have  shown,  in  various  publications,  the 
importance  of  physical  exercise  in  the  open  air,  cleanliness,  cheerful- 
ness, and  a strict  regard  to  temperance  in  all  things,  I am  led  to 
conclude,  from  my  own  experience  and  from  observation,  that  too 
little  has  been  said  or  written  upon  the  importance  of  proper  breath- 
ing, and  its  beneficial  effects  upon  the  whole  system. 

, The  late  Dr.  Talmadge  Sutherland,  of  this  city,  taught  that  one 


14 


IXTRODUCTION. 


of  the  principal  causes  of  indigestion  is  improper  breathing,  which  pro- 
duces a total  disarrangement  of  the  abdominal  viscera  and  the  circula- 
tion of  the  fluids,  with  a contraction  of  the  muscles ; that  the  action  of 
the  diaphragm  becomes  inadequate  to  perform  its  proper  requirement, 
producing  indigestion,  which,  if  not  remedied,  would  eventually  be  fol- 
lowed by  pulmonary  consumption  ; and  that  the  principal  cause  which 
leads  to  improper  breathing  is,  an  anxious  state  of  mind,  produced  by 
disappointments,  losses,  or  embarrassments,  &c.  This  improper 
breathing,  such  as  sighing,  or  the  like,  he  styled  an  upward  breath- 
ing. In  treating  his  patients  he  particularly  laboured  to  correct  the 
breathing.  I owe  my  recovery  from  a low  state  of  health,  of  full 
three  years’  standing,  (in  which  I was  entirely  unfitted  for  business, 
by  indigestion,)  to  him,  after  having  been  medically  treated  by 
some  of  the  most  eminent  physicians  of  this  city  and  elsewhere. 
And  to  my  certain  knowledge  he  was  also  instrumental  in  recover- 
ing many  to  health  and  usefulness  who  could  get  no  benefit  from 
the  usual  medical  treatment,  and  who  had  no  prospect  before  them 
but  of  dragging  out  a miserably  useless  existence. 

^The  following  facts  will  not  be  uninteresting.  The  testimony  of  a 
gentleman  with  w^hom  I travelled  some  distance  in  England  is  in  point. 
He  informed  me  that  three  oil’  four  years  ago  he  had  repeated  attacks  of 
hemorrhage  of  the  lungs,  and  that  he  cured  himself  by  rising  early  in 
the  morning,  and  walking  out  on  some  hills  adjacent,  and  taking  deep 
inspirations  for  an  hour  at  a time. 

The  Rev.  John  Wesley  states  that  he  has  known  a deep  con- 
sumption to  be  cured  by  putting  a sod  of  turf  to  the  nostrils  and  taking 
the  scent  of  the  earth. 

I am  indebted  to  Dr.  North,  of  Saratoga,  for  the  following  fact : — 

“ Dr.  Dewees,  of  Philadelphia,  recovered  from  frequent  hemorr- 
hages from  the  lungs,  when  young,  by  playing  the  flute,  which  prac- 
tice he  adopted  with  the  express  object  of  removing  a threatened  con- 
sumption.” 

The  exercise  in  the  lungs,  by  the  use  of  wind  instruments,  beneficial 
as  it  may  have  been  in  this  solitary  instance,  is  by  no  means  to  be 
recommended,  as  it  is  a constant  effort  to  expel  from  the  body  the  air, 
while  little  opportunity  is  offered  to  permit  the  person  fully  to  inflate 
the  lungs  by  drawing  a full  and  deep  inspiration ; and  although  it  pro- 
duces exercise  in  the  lungs,  it  is  the  opposite  of  the  healthy  and  vigor- 
ous exercise  resulting  from  healthy  breathing,  or  breathing  through 
the  tube. 

The  Rev.  John  Hodgson,  jr.,  of  Middlesborough  on  Tees,  En- 
gland, gave  me  the  following  interesting  account  of  a gentleman  edu- 
cated as  a physician,  who,  on  leaving  his  profession  for  the  pulpit. 


INTRODUCTION. 


15 


after  a few  years  was  taken  with  a throat  disease,  with  loss  of  voice, 
and  great  debility  of  the  chest.  After  being  medically  treated  without 
benefit,  he  was  informed  by  the  faculty  that  he  would  jeopard  his  life 
by  any  further  attempts  at  public  speaking,  and  that  it  was  necessary . 
to  abandon  it  entirely.  He  resumed  his  medical  practice,  and  subse- 
quently the  thought  occurred  to  him,  that  he  had  read  in  his  youth  of 
the  great  importance  of  correct  breathing,  and  of  breathing  through  the 
nostrils.  He  at  once  commenced  this  mode  of  breathing,  taking  deep 
inspirations : after  thus  practising  a few  months  he  was  perfectly 
restored  to  health,  and  his  voice  was  so  strengthened,  that  for  many 
years  he  could  with  ease  address  the  largest  public  assemblies  in  the 
most  spacious  buildings. 

The  following  remarks  on  the  structure  of  the  lungs,  and  the  benefi- 
cial effects  of  proper  respiration,  are  from  Combe’s  Physiology,  a work 
of  acknowledged  merit,  which  is  extensively  before  the  public  : — 

“The  substance  of  the  lungs  consists  bronchial  tubes,  air-cells,  blood- 
vessels, nerves,  and  cellular  membrane,  or  parenchyma.  The  first  are 
merely  continuations  and  subdivisions  of  the  windpipe,  and  serve  to 
convey  the  external  air  to  the  air-cells  of  the  lungs.  The  air-cells 
constitute  the  chief  part  of  the  pulmonary  tissue,  and  are  in  one  sense 
the  termination  of  the  smaller  branches  of  the  bronchial  tubes.  When 
fully  distended,  they  are  so  numerous  as  in  appearance  to  constitute 
almost  the  whole  lung.  They  are  of  various  sizes,  from  the  20th  to 
the  100th  of  an  inch  in  diameter,  and  are  lined  with  an  exceedingly 
fine  thin  membrane,  on  which  the  minute  capillary  branches  of  the 
pulmonary  arteries  and  veins  are  copiously  ramified ; and  it  is  while 
circulating  in  the  small  vessels  of  this  membrane,  and  there  exposed 
to  the  air,  that  the  blood  undergoes  the  change  from  the  venous  to  the 
arterial  state.  So  prodigiously  numerous  are  these  air-cells  that  the 
aggregate  extent  of  their  lining  membrane  in  man  has  been  computed 
to  exceed  a surface  of  20,000  square  inches. 

“ It  may  be  thought  that  the  interposition  of  such  a membrane  must 
have  the  effect  of  preventing  any  action  of  the  air  upon  the  hlood. 
But,  in  addition  to  the  proof  to  the  contrary  drawn  from  observation, 
it  has  been  ascertained  by  experiment  that  even  the  thick  and  firm 
texture  of  the  bladder  is  insufficient  to  prevent  the  occurrence  of  the 
change ; venous  blood  confined  in  a bladder  speedily  becoming  of  a 
florid  red,  like  arterial  blood. 

“ The  free  and  easy  expansion  of  the  chest  is  obviously  indispensa- 
ble to  the  full  play  and  dilatation  of  the  lungs  ; whatever  impedes  it, 
either  in  dress  or  in  position,  is  prejudicial  to  health ; and,  on  the  other 
hand,  whatever  favours  the  free  expansion  of  the  chest  equally  promotes 
the  healthy  fulfilment  of  the  respiratory  functions.  Stays,  corsets,  and 
tight  waistbands,  operate  most  injuriously,  by  compressing  the  tho* 
racic  cavity  and  impeding  the  due  dilatation  of  the  lungs  ; and  in  many 
instances  they  give  rise  to  consumption.  I have  seen  one  case,  in 
which  the  liver  was  actually  indented  by  the  excessive  pressure,  and 
long  continued  bad  health  and  ultimately  death  were  the  results.  In 
allusion  to  this  subject,  MI.  Thackrah  mentions,  that  men  can  exhale. 


16 


INTRODUCTION. 


at  one  effort,  from  six  to  ten  pints  of  air,  whereas  in  women  the  ave. 
rage  is  only  from  two  to  four  pints.  In  ten  females,  free  from  disease, 
whom  he  examined  about  the  age  of  18^,  the  quantity  of  air  thrown 
out  averaged  3^  pints ; while,  in  young  men  of  the  same  age,  he  found 
it  amount  to  six  pints.  Some  allowance  is  to  be  made  for  natural 
differences  in  the  two  sexes,  but  enough  remains  to  show  a great  di- 
minution of  capacity,  which  can  be  ascribed  to  no  other  cause  than 
the  use  of  stays. 

“Judicious  exercise  of  the  lungs  is  one  of  the  most  efficacious  means 
which  we  can  employ  for  promoting  their  development  and  warding 
off  their  diseases.  In  this  respect  the  organs  of  respiration  closely 
resemble  the  muscles  and  all  other  organized  parts.  They  are  made 
to  be  used,  and  if  they  are  left  in  habitual  inactivity  their  strength  and 
health  are  unavoidably  impaired. 

“ When  the  chest  is  expanded  by  a full  inspiration,  the  bowels  are 
pushed  downward  and  forward  to  make  way  for  the  lungs ; when 
the  air  is  again  expelled,  and  the  cavity  of  the  chest  diminished,  the 
very  muscles  which  effect  this  by  pulling  down  the  ribs  contract 
upon  the  bowels  also,  and  push  them  upward  and  inward,  as  can  be 
plainly  perceived  by  any  one  who  attends  to  his  own  breathing.  By 
this  contrivance,  a gentle  and  constant  impulse  is  given  to  the  stomach 
and  bowels,  which  is  of  great  importance  to  them  in  contributing  to 
digestion  and  in  propelling  their  contents.” 

He  remarks  further  upon  respiration  and  animal  heat : — 

“ The  relation  between  the  production  of  animal  heat  and  the  con- 
dition  of  the  respiratory  functions,  is  the  most  direct  and  remarkable. 
In  general,  other  conditions  being  alike,  heat  is  generated  more  or  less 
freely,  in  proportion  to  the  size  and  vigour  of  the  lungs ; and  when 
these  are  impaired,  the  production  of  heat  is  diminished.  Hence  many 
persons  with  imperfectly  developed  lungs,  and  a predisposition  to  con- 
sumption, complain  habitually  of  coldness  of  the  surface  and  feet ; 
and  many  who  were  previously  in  good  health  become  more  and  more 
sensible  to  cold,  in  proportion  as  the  approach  of  disease  weakens  the 
functions  of  the  lungs.  I have  noticed  this  increased  sensibility  to 
cold  as  a precursor  of  chronic  pulmonary  disease,  both  in  myself  and 
others,  before  any  other  very  ostensible  symptom  had  appeared,  and 
think  I have  seen  its  further  progress  arrested  by  the  timely  use  of 
proper  means,  where  much  greater  difficulty  would  have  been  expe- 
rienced had  the  warning  not  been  attended  to. 

“ The  generation  of  heat  in  the  living  system  being  so  immediately 
connected  with  the  lungs,  we  find  the  temperature  highest  in  those 
animals  who  possess  them  in  the  greatest  perfection,  viz.  birds.  In 
many  species,  the  internal  heat  exceeds  that  of  man  by  twenty  or  thirty 
degrees;  while  that  of  man  exceeds,  to  as  great  an  extent,  the  heat 
of  such  of  the  inferior  animals  as  are  remarkable  for  imperfect  organs 
of  respiration.” 

Beneficial,  however,  as  is  correct  breathing,  and  necessary  as  it  is  to 
the  enjoyment  of  health,  yet  I well  know  that  it  is  exceedingly  diffi- 
cult for  a person  in  a low  state  of  health  to  perform  it  so  as  to  give  a 
healthy  and  vigorous  exercise  to  the  pulmonary  muscles  or  digestive 


INTRODUCTION. 


17 


organs,  without  some  contrivance  to  assist.  I know  of  nothing  so 
well  calculated  to  afford  this  exercise,  expansion,  and  full  develop- 
ment of  the  lungs,  as  the  tube ; a few  months’  use  of  it  by  the  invalid 
will  so  call  the  chest  into  action  as  to  enable  him  to  breathe  well  with-' 
out  it. 

The  practice  of  Dr.  Ramadge,  however,  is  entirely  new  in  this 
country,  and  time  must  elapse  ere  it  will  be  extensively  known,  adopt- 
ed, or  even  fairly  experimented  on;  but  from  the  reception  it  has  already 
received  from  some  physicians  and  other  persons,  I am  encouraged  to 
hope  that  it  may  be  brought  into  general  use. 

If  the  principles  of  practice  laid  down  in  this  book  be  true,  (and  I 
verily  believe  they  are,  if  fairly  adopted  and  practised,)  how  many  a 
pallid,  cadaverous  countenance  might  again  be  flushed  with  health ; 
how  many  a feeble  limb  again  nerved  and  strengthened ; and  how 
many  a family  made  to  rejoice  that  their  stay  and  only  hope  in  life 
might  yet  be  permitted  to  tarry  with  them  ! 

But  even  though  it  should  not  accomplish  all  that  is  asserted,  yet 
it  still  claims  a fair  and  impartial  trial ; for  if  it  fail  at  last,  it  will  do 
no  more,  or  accomplish  no  less,  than  all  other  means  that  have  been 
used  in  consumption  for  ages  before  it.  But  of  this  much  I am  cer- 
tain, the  means  are  so  simple,  and  the  exercise  of  inhaling  so  grateful 
and  soothing  to  the  patient,  affording  him  exercise  and  pastime,  that 
it  will  at  least  contribute  to  smooth  his  pathway  to  the  tomb.  But  it 
has  been  objected,  by  some  physicians,  that  inhalation  would  be  im- 
proper in  some  stages  of  consumption.  So  says  Dr.  R.,  in  his  re- 
marks on  inhalation. 

“ There  are  cases  in  which  inhalation  is  contraindicated  ; for  in- 
stance, in  dilation,  or  hypertropha  of  the  heart,  severe  mucus  catarrh, 
general  emphysema  of  the  lungs,  pleuritic,  or  pneumonic  inflamma- 
tion, haemoptysis,  or  latent  consumption,  of  long  standing.” 

It  has  been  remarked  by  others  that  inhalation  cannot  effect  a cure 
in  all  cases.  So  says  Dr.  R., 

“ No  permanent  benefit  is  to  be  expected  from  this  remedy,  when  the 
inferior  lobes  of  the  lungs  contain  cavities,  or  are  studded  with  tuber- 
cles ; yet,  even  in  this  unfavourable  state  I have  known  relief  arise, 
and  surprising  prolongation  of  life  ensue,  from  its  employment.  I have 
individuals  under  my  care,  at  this  moment,  in  whom  one  lung  is 
almost  useless  from  extensive  tuberculous  disease,  and  with  even  well- 
marked  pectoriloquy  on  the  top  of  the  opposite  lung ; still,  from  having 
the  rest  of  the  lung  on  this  side  in  a satisfactory  state,  and  thus  being 
partially  susceptible  of  the  influence  of  inhalation,  the  progress  of 
consumption  has  been  arrested ; and  in  more  than  one  instance,  the 
relief  afforded  by  inhaling  has  enabled  the  individual  to  attend  to  the 
duties  of  his  calling — of  course  no  very  onerous  ones.  Indeed,  I shall 
feel  happy  to  introduce  any  of  my  readers,  who  may  entertain  a desire 
to  see  such  remarkable  instances  of  inhalation,  to  these  patients  of 
mine.” 


S 


18 


INTRODUCTION. 


The  doctor  repeatedly  assured  me,  that  persons  of  narrow  chests,  or 
whose  system  was  in  a bad  state,  or  those  who  were  hereditarily  pre- 
disposed to  consumption,  would  entirely  be  prevented  from  falling  into 
it,  if  they  would  persist  in  the  course  of  inhalation  for  about  six  months, 
or  longer ; it  will  however  require  some  effort  and  perseverance,  par- 
ticularly in  persons  decidedly  consumptive,  who  will  occasionally  be 
discouraged  by  the  return  of  the  hectic  fever,  night  sweats,  and 
shortness  of  breathing,  and  sometimes  of  soreness  in  the  chest,  all  of 
which  are  to  be  treated  medicinally  as  directed. 

The  general  use  of  the  tube,  however,  I fear,  notwithstanding  the 
clearness  with  which  the  doctor  has  pointed  out  the  proper  persons  by 
whom  it  should  be  used,  and  how  and  when  it  should  be  used  and 
when  laid  aside,  and  the  medical  course  to  be  |)ursued  in  connection 
with  it,  will  be  greatly  hindered  by  its  injudicious  employment ; some 
will  use  it  when  the  lungs  are  in  a state  of  inflammation,  without 
first  reducing  it,  as  directed,  by  local  depletion,  &;c.,  and  some,  when 
labouring  under  great  oppression  of  the  chest,  or  shortness  of  breath- 
ing ; it  will  be  used  by  those  whose  lungs  are  asthmatic,  and  by  others 
who  are  afflicted  with  disease  in  the  heart,  &:c.  Those,  however,  to 
whom  it  is  likely  to  be  beneficial,  will,  by  pursuing  a course  of  inhala- 
tion for  months,  experience  a variety  of  sensations  and  changes  of  the 
chest,  (which  at  times  will  be  sore,  on  account  of  the  expansion  and  ex- 
ercise,) and  also  a more  free  expectoration,  upon  the  softening  down  of 
the  tuberculous  matter.  Without  a proper  knowledge  of  some  of  the 
probable  effects  resulting  from  its  use,  one  would  hardly  have  patience 
and  perseverance  to  continue  it ; but  for  the  instructions  received  from 
time  to  time  from  the  doctor  since  my  return,  I should  myself  have 
been  in  doubt.  I am,  however,  sure,  if  used  as  directed,  it  will  ac- 
complish all  that  the  doctor  asserts.  In  conclusion,  I would  add,  that 
my  only  design  in  the  republication  of  this  work  in  this  country  is,  to 
spread  information  which  I conceive  to  be  invaluable, — information 
which  has  prolonged  my  life  and  the  lives  of  others  ; humbly  praying 
that  it  may  be  a mean  for  the  prevention  of  this  dire  disease,  and 
the  restoration  of  the  health  of  many. 

I greatly  regret  my  inadequacy  to  present  this  subject  to  the  public 
as  it  should  be,  and  most  sincerely  wish  it  had  fallen  into  abler  hands  ; 
but,  notwithstanding  my  insufficiency,  I have  no  desire  to  shrink  from 
the  task,  most  sincerely  believing  that  I am  acting  in  the  order  of 
providence. 


PREFACE 


TO  THE  FIRST  EDITION. 

Most  men  have  some  one  darling  wish,  which  forms  the  central 
point  to  which  all  their  ideas  and  feelings  verge.  My  attention  was 
directed  at  my  outset  in  the  profession  to  that  tremendous  disease, 
which,  from  its  wasting  effects  on  the  human  frame,  too  truly  and 
appropriately  bears  the  name  of  consumption.  I found  those  to  whose 
experience  I looked  to  direct  and  guide  me,  themselves  walking  in 
the  dark.  Books  only  displayed  to  me  a mass  of  crude,  ill-arranged, 
unreasoned-upon  facts,  or  the  fanciful  chimeras  of  medical  visionaries. 
I saw  that  those  branches  of  knowledge  which  had  been  redeemed 
from  the  wastes  of  empiricism,  and  brought  within  the  pale  of  art, 
had  been  indebted  for  this  successful  issue  to  the  system  of  induction 
which  owns  Bacon  as  its  father.  The  assemblage  of  facts  without 
classification,  and  this  last  without  careful  investigation  of  specific 
differences,  might,  and  did,  I perceived,  pass  for  labour  and  observation, 
but  was  certaihly  not  science.  I felt  mortified  and  degraded  at  the 
utter  inefficacy  of  medicine,  and  of  medical  art,  in  this  the  common- 
est of  diseases ; and  I was  soon  convinced  that  the  only  means  of  res- 
cuing  my  profession  from  this  “darkness  visible”  was  to  make  the 
physician  subordinate  to  the  anatomist.  I had  yet  a higher  object  in 
view — that  of  mitigating  human  suffering.  I have  toiled  to  this  end, 
and  what  I felt  to  be  my  duty  has  been  my  reward.  In  no  boastful 
spirit  do  I speak,  but  in  a thankful  one.  I have  proved  that  there  is 
a cure  for  what  has  hitherto  been  deemed  incurable  ; and  this,  no 
drug  known  but  to  its  compounder,  but  a simple  mechanical  process 
available  to  all.  That  which  has  been  as  yet  confused,  is,  I would 
hope,  rendered  clear  : and  I trust  that  modes  of  treatment  resulting  up 
to  this  period  from  conjecture,  and  leading  but  too  often  to  confirm 
the  disease  they  were  intended  to  cure,  will  soon  pass  away  with  other 
exploded  practice,  that  now  moves  but  our  pity,  or  our  disgust. 

March,  1834. 


PREFACE 

TO  THE  SECOND  EDITION. 

“It  is  passing  strange”  that  medical  attention,  in  this  country, 
should  have  been  so  little  directed  to  the  pathological  consideration  of 
consumption.  Nor  is  it  less  so,  that  consumptive  patients  are  expressly 
excluded  by  the  regulations  from  more  than  one  of  the  metropolitan 
hospitals.  We  are  chiefly  indebted  to  foreign  writers  for  anatomical 
investigations  of  the  various  diseases  connected  with  the  chest ; al- 
though they  have  done  but  little  toward  developing  any  plan  of  treat- 
ment, holding  out  decided  hopes  of  success,  in  consumption.  The 


20 


PREFACE. 


ill  fortune  which  characterized  the  means  usually  pursued  by  the 
profession,  in  consumptive  cases,  early  struck  my  attention.  My 
medical  brethren  appeared,  with  respect  to  this  disease,  to  be  as  rigid 
fatalists  as  the  Mohammedan  ; and  to  resign  themselves  calmly  to  the 
belief,  that  when  once  consumption  appeared,  human  efforts  could  be 
of  no  avail.  Yet  this  apathetic  resignation  was  neither  consistent 
with  reason  nor  with  sound  philosophy.  No  man  could  feel  more 
deeply  than  myself  that  the  issue  is  ever  in  the  hands  of  the  Omnipo- 
tent ; but  I could  not  bring  myself  to  the  conclusion,  that,  because 
failure  had  hitherto  attended  human  agency,  to  cure  was  therefore 
impossible.  I could  not  sit  down  like  our  oriental  prototypes,  with 
the  exclamation,  “ Allah  Akbar!”  and  do  nothing.  Such  were  my  im- 
pressions, and  such  my  reasoning,  twenty  years  ago.  It  appeared  to 
me,  that  not  only  the  treatment  of  pulmonary  consumption  was  ill 
understood,  but  that  the  pathology  of  most  of  the  affections  of  the 
chest  had  not  received  that  investigation  which  they  deserved.  Yet 
none  are  more  important,  or  indeed,  taking  their  number  into  consi- 
deration, so  much  so  ; seeing  that  the  heart  and  lungs  constitute  the 
two  main  props  of  what,  together  with  the  brain,  Bordeu  felicitously 
terms  the  tripod  of  life.  For  the  time  just  mentioned,  it  has  been  one 
of  the  chief  objects  of  my  professional  labours  to  advance  our  know- 
ledge  of  this  interesting  class  of  diseases.  The  vacancy  which  the 
resignation  of  Dr.  Buxton,  (for  several  years  physician  to  the  London 
Hospital,)  left  at  the  Infirmary  for  Diseases  of  the  Chest,  presenting 
the  only  favourable  opportunity  London  affords  for  seeing,  in  large 
numbers,  every  variety  of  case  connected  with  pulmonary  and  other 
affections  of  the  chest,  was  eagerly  embraced  by  me.  I was  fortunate 
enough  to  obtain  the  situation  of  physician  to  the  Infirmary  ; and  trust 
that  the  present  work  will  prove  that  I have  not  misemployed  the  abund- 
ant facilities  it  holds  out  for  investigating  the  pathology  of  these  diseases. 

I feel  a sincere  pleasure  in  stating  the  reception  which  the  first  edi- 
tion of  “ Consumption  Curable”  has  met  with  from  the  liberal  portion 
of  my  profession.  The  letters  I have  received,  from  intelligent  prac- 
titioners in  every  part  of  the  United  Kingdom,  have  gratified  me  in 
more  than  a selfish  point  of  view.  They  have  proved  to  me  that, 
however  interested  motives  may  bias  some,  there  is  an  active  and  hon- 
ourable spirit  abroad  in  the  profession  at  large,  which  induces  a frank 
and  manly  openness  to  conviction.  The  owls,  who  shut  their  eyes  to 
the  light  of  truth,  because  it  would  guide  others  through  the  “ palpable 
obscure,”  are  likely  soon  to  be  left  alone  in  their  blindness.  An  amended 
medical  education  will  rectify  all  these  things. 

It  will  not  be  thought  that  I overrate  the  importance  of  the  diseases 
affecting  the  chest,  when  it  is  considered  that  scarcely  any  part  of  the 
body  can  be  indisposed  without  the  chest’s  participating.  Yet  it  is 
consolatory  to  reflect,  to  employ  the  words  of  Laennec,  that  ‘‘Quelque 
dangereuses  que  soient  les  maladies  de  la  poitrine  elles  sont  cependant 
plus  sou  vent  curables  qu’  aucune  autre  maladie  interne  grave.” 

September,  1834, 


PBEFACE. 


21 


PREFACE 

TO  THE  THIRD  EDITION. 

In  answering  the  demand  for  a new  edition  of  the  present  work,  it 
is  gratifying  to  state  that  I find  my  opinions  are  rapidly  gaining  ground 
abroad,  and  steadily  extending  at  home.  To  the  German  translators, 
especially,  of  “ Consumption  Curable,”  for  it  has  been  honoured  by 
several  distinct  translations  into  that  language,  and  to  Dr.  Hohnbaum, 
in  particular,  I am  much  indebted.  The  prefacd  of  this  justly  cele- 
brated individual  is  liberal  and  philosophic.  Too  thoroughly  informed 
in  his  art  to  deny  the  curability  of  phthisis,  he  was  of  too  enlarged  a 
mind  to  refuse  my  system  a fair  trial  merely  on  the  score  of  its  nov- 
elty, and  too  high  principled  to  withhold  his  testimony  to  its  success. 
In  the  Appendix  will  be  found  the  cases  with  which  he  has  enriched 
his  translation. 

I may  mention  it  as  a proof  of  the  earnestness  of  the  foreign  med- 
ical press  in  the  diffusion  of  our  common  art,  that  translations  of  my 
work  have  been  forwarded  to  me  from  the  most  opposite  parts  of  the 
continent.  The  last  I have  received  is  from  the  pen  of  Dr.  Schmidt, 
and  was  published  at  Pest,  Hungary  : it  is  a second  edition  of  my 
first  edition. 

In  this  country,  likewise,  I am  proud  and  anxious  to  acknowledge, 
that  if  I have  encountered  much  prejudice,  I have  also  met  with  great 
liberality.  The  cases  submitted  to  me  by  country  practitioners  would 
alone  be  satisfactory  evidence  of  the  spread  of  sounder  opinions  on 
the  pathology  and  treatment  of  pulmonary  consumption.  But  this 
acknowledgment  is  not  to  be  confined  to  the  provinces.  Were  it  not 
for  the  fear  of  exposing  them  to  ungenerous  attacks  and  the  vexations 
of  professional  controversy,  I might  name  several  eminent  physicians 
of  the  metropolis  who  coincide  with  my  views  frankly  and  fairly; 
others  there  are  who  quietly  imitate  my  practice,  and  thus  tacitly  pay 
it  the  best  compliment ; while  the  numerous  cases  to  which  I am 
called  in  by  the  general  practitioner,  warrant  me  in  believing  that  I was 
not  too  sanguine  when  I ventured  to  say  in  my  first  preface — “ I trust 
that  modes  of  treatment,  resulting  up  to  this  period  from  conjecture, 
and  leading  but  too  often  to  confirm  the  disease  they  were  intended  to 
cure,  will  soon  pass  away  with  other  exploded  practice  that  now  moves 
but  our  pity,  or  our  disgust.” 

Still,  as  must  ever  be  expected  in  the  outset,  there  is  no  lack  of  op- 
position to  these  views.  Many  refuse  to  examine  their  validity  : many 
examine,  with  a fixed  determination  not  to  be  convinced.  Others 
again  esteem  themselves  too  much  to  credit  the  possibility  of  cure 
where  they  have  failed  : it  would  be  to  deny  their  own  talent,  to  con- 
fess their  own  inferiority,  in  short — a bad  compliment  to  self.  Some 
there  may  be — but  this  is  hypothetical — who  regard  the  increasing 
reputation  of  another  as  so  much  subtracted  from  their  own  treasury. 
With  such,  the  abridging  the  duration  of  disease,  and  still  more 
the  preventing  its  ingression,  is  to  “ bring  down  the  rate  of  usance 


22 


PREFACE. 


here to  cure,  above  all  to  avert  the  need  of  cure,  is  not  in  their 
“ bond.” 

Since  the  publication  of  the  present  treatise,  three  works  have  is- 
sued from  the  press  on  the  same  subject,  or  partly  so.  It  would  be 
uncourteous  to  pass  them  over  in  silence ; and  I am  quite  willing  to 
give  them  the  “ honour  due.”  They  differ  in  point  of  literary,  and 
are  unequal  as  regards  their  medical  merit ; but,  in  one  respect,  they 
are  on  the  same  level.  Their  authors  agree  that  they  cannot  cure 
consumption,  which  is  highly  probable ; they  likewise  agree  that  it 
cannot  be  cured,  which  is  directly  opposed  to  the  highest  authority  on 
the  subject,  and  is  the  reverse  of  my  own  experience.  To  begin  with 
the  work  of  Dr.  James  Clark.  Since  this  gentleman  passed  the  greater 
part  of  his  professional  life  (at  least  before  I had  the  honour  of  being 
one  of  his  examiners  at  the  college  of  physicians)  among  the  Eng- 
lish resident  in  Rome,  his  field  of  observation  must,  I presume,  have 
been  rather  limited.  However,  taking  Laennec,  Louis,  and  Andral 
for  his  guides,  he  has  produced  a very  neat  compilation  from  their  ad- 
mirable volumes.  His  work  is  destitute  of  originality,  to  which,  I 
should  suppose,  its  author  hardly  lays  claim.  The  point  on  which  he 
insists  most  strongly  is,  that  “ the  constitutional  origin  of  tubercles, 
by  far  the  most  important  part  of  the  subject,  has  been  neglected 
and  he  would  appear  by  the  context  to  imagine  that  he  was  fixing  at- 
tention for  the  first  time  on  an  essential  principle,  since  he  adds,  “ if 
we  succeed  in  giving  a satisfactory  exposition  of  this,  the  most  im- 
portant, but  hitherto  most  neglected  part  of  our  subject,  we  may  hope 
to  lay  the  foundation  of  a sounder  pathology  of  tuberculous  disease.’^ 
Nothing  can  be  more  true  ; but,  without  referring  to  the  writers  who 
precede  us  both,  had  he  bestowed  a glance  on  my  pages,  he  would  have 
seen  the  same  doctrine  strenuously  insisted  upon.  To  adduce  one,  out 
of  various  passages  of  like  tenour,  I observe,  “Many  writers  are 
of  opinion,  that  various  thoracic  diseases  are  a fruitful  cause  of  con- 
sumption ; but  I am  satisfied  that  this  supposition  is  groundless.  It  is 
merely  owing  to  the  loss  of  health  entailed  by  them,  that  the  develop- 
ment of  those  accidental  productions  called  tubercles  takes  place.  To 
enumerate  the  various  causes  of  consumption  would  be  endless  ; for, 
in  fact,  whatever  is  capable  of  impairing  the  constitution  is  liable  to 
produce  a phthisical  state. Surely  the  doctor’s  “exposition”  and 
mine  are  convertible — alter  et  idem. 

Would  it  not  lead  to  too  great  a length,  I should  feel  proud  to  bring 
forward  the  coincidences  which  occur  between  Dr.  Clark’s  work  and 
mine,  whenever  he  propounds  any  notion  bearing  the  appearance  of 
novelty.  Yet,  by  a strange  predilection  for  the  despairing  side  of  the 
question,  he  invariably  declines  following  out  such  notions  to  their 
practical  results.  He  appears  to  labour  under  a morbid  dread  of  the 
curability  of  consumption  ; although,  in  deference  to  Laennec,  he  is 
constrained  to  admit  those  pathological  facts  on  which  I ground  the 
rationale  of  my  practice.  Thus  he  confesses,  that  “ although  caverns 
generally  tend  to  increase  in  size,  yet  not  infrequently  when  they  occur 
singly,  and  when  no  fresh  depositions  of  tubercles  take  place,  they 
remain  a long  while  stationary.  In  cases  still  more  uncommon,  they 
gradually  contract  and  become  obliterated.’’  Again,  “ in  a very  large 
proportion  of  cases,  it  is  only  in  the  early  stage  we  can  hope  to  effect 


PHEFACE. 


23 


a cure.”  There  are  some,  then,  that  may  be  cured  at  a more  advanced 
stage  1 Euge  ! the  doctor  after  this  may  surely  go  a step  further, 
and  exclaim  with  Laennec,  “ Cure  in  cases  of  pulmonary  phthisis, 
in  which  complete  disorganization  of  the  lungs  has  not  taken  place, 
ought  not  to  be  considered  impossible,  either  as  regards  the  nature 
of  the  disease,  or  the  organ  affected.’’  It  is  singular  that  a medical 
man  should  deny  the  curability  of  phthisis,  after  excepting  “ the 
small  proportion  of  cases  in  which  the  tuberculous  deposite  is  confined 
within  narrow  limits.”  If  we  believe  this  writer,  consumption  is  not 
curable — but  there  are  exceptions,  it  seems.  Truly  there  are ; and 
had  these  cases  of  exception  been  thoroughly  investigated,  and  the 
process  by  which  they  were  effected  diligently  traced,  the  instances 
of  failure  would  long  since  have  taken  their  place,  and  have  themselves 
become  the  exceptions.  I speak  confidently  on  this  head,  as  my  ex- 
perience warrants  it. 

The  doctor,  too,  by  some  unhappy  slip  of  memory,  is  at  variance 
with  another  writer,  a coadjutor  of  his  in  the  ‘‘  Cyclopaedia  of  Practi- 
cal  Medicine,”  for  whom  he  professes  a profound  deference.  This 
gentleman,  Dr.  Carswell,  observes  in  his  article  on  “ Tubercle,” 
speaking  of  consumption,  “ The  important  fact  of  the  curability  of 
this  disease  has,  in  our  opinion,  been  satisfactorily  established  by 
Laennec.”  And  let  me  add,  in  the  opinion  of  every  one  who  has 
read  the  immortal  work  of  that  great  man — and  understood  it.  Dr. 
Clark,  however,  does  not  absolutely  deny  the  possibility  of  curing  the 
disease,  but  “ damns  with  civil  sneer.”  Cases  of  cure  do  happen, 
rare  exceptions.  Of  course,  rare  enough  with  those  who  do  not 
know  how  to  treat  the  disease.  Rare  and  fortuitous,  I grant,  pre- 
viously to  the  appearance  of  my  publication.  Yet,  although  his  own 
treatment  may  be  productive  of  any  thing  but  satisfactory  results, 
why  not  state  with  Laennec,  that  there  is  no  valid  reason,  “ either  as 
regards  the  nature  of  the  disease,  or  the  organ  affected,’’  why  con- 
sumption should  not  be  cured  ? Why  so  lachrymose,  when  his  chief 
authority  holds  out  such  hope  1 

The  above  writer  is  “ followed  to  the  field’’  by  Dr.  T,  Davies  ; the 
motto  to  whose  lectures  on  diseases  of  the  chest  might  aptly  be 
“ ahandonate  speranza  voi  cE  entrate.'^  This  work  seems  to  be  a 
synopsis  of  that  of  Laennec ; and  is  inferior  to  Dr.  Clark’s,  inas- 
much as  it  is  chiefly  borrowed  from  one  authority,  instead  of  from 
three  or  four.  But,  on  the  favourite  point.  Dr.  Davies  has  deviated 
from  his  sworn  guide  still  further  than  Dr.  Clark.  The  one  is  re- 
luctant to  admit  the  curability  of  consumption,  allowing,  however,  that 
such  an  event  does  occasionally  happen  ; the  other  boldly  proclaims, 
in  the  teeth  of  his  exemplar,  that  it  is  not  curable.  He  speaks,  I pre- 
sume, from  his  own  experience  : he  may  have  been  uniformly  unsuc- 
cessful, and  hence  his  claim  to  be  so  positive.  Yet,  incurable  as  he 
may  have  found  the  disease,  it  is  singular  that  after  following  La- 
ennec with  almost  servile  idolatry,  he  should  arrive  at  directly  oppo- 
site conclusions.  Laennec  supposed,  and  truly,  that  he  had  not  only 
discovered  a series  of  signs  throwing  the  clearest  light  on  the  diag- 
nosis of  consumptive  disease,  but,  that  by  establishing  its  pathology 
on  a broader  and  sounder  basis,  he  had  proved  the  possibility  of  cure, 
and  paved  the  way  for  important  practical  results.  Dr.  Davies,  how- 
ever, although  he  has  lit  his  own  rushlight, 


24 


PBSFACS. 


(“  And  lights  hia  farthing  candle  at  the  sun”) 

at  the  lamp  of  that  great  man,  and  painfully  picks  his  steps  by  its  as- 
sistance, suddenly  extinguishes  it  as  he  approaches  his  labours’  end^ 
and  jumps  for  safety  into  the  slough  of  despond.  “ Follow  Laennec,” 
he  exclaims  to  his  pupils,  “ I can  give  you  no  better  guide  ; but  do  not 
go  straight  to  the  mark  with  him  and  attempt  to  cure  consumption  ; 
stop  short  and  be  warned  by  me, — for  I have  enjoyed  a liberal  allow- 
ance of  failure, — that  it  cannot  be  cured.’’ 

Another  of  our  medical  illuminati.  Dr.  Latham,  of  St.  Bartholo- 
mew’s, has  condescended  to  complete  the  triumvirate,  and  has  just 
published  his  version  of  Laennec,  under  the  title  of  “ Lectures  on  Sub- 
jects connected  with  Clinical  Medicine.”  After  an  introduction,  in 
which  he  informs  us  that  surgery  is  more  popular  than  medicine, 
“ because  it  is  easier,”  he  proceeds  to  treat  of  the  signs  afforded  by 
auscultation.  These  he  divides  into  the  moist  and  dry,  and  appears 
to  conceive  that  he  has  thus-  made  a novel  and  important  distinction. 
So  in  fact  he  would,  did  he  not  labour  under  the  disadvantage  of 
having  been  anticipated  by  Laennec.  As  a specimen  of  the  innocent 
method  in  which  he  assumes  the  tone  of  a discoverer,  I quote  his  con- 
jectures as  to ' the  causes  productive  of  the  sign  which  is  termed 
sihilus.  “ Sibilus  may  then,  (in  spasmodic  asthma,)  if  ever,  be  truly 
called  a dry  sound.  But  I am  not  sure  that  the  sibilus  directly  re- 
sults from  the  mere  condition  of  dryness ; I doubt  whether  simple 
dryness  alone  naturally  would  produce  it.  In  consequence  of  its  dry- 
ness, the  mucous  membrane  may  lose  its  elasticity,  and  become,  to  a 
certain  degree,  unyielding  ; or  it  may  undergo  wrinklings,or  puckerings, 
at  various  spaces  ; or  its  general  tumefaction  may  produce  a narrowing 
of  the  smaller  tubes,  and  thus  present  obstacles  to  the  passage  of  air, 
and  impart  to  it  new  vibrations ; and  hence  the  sibilus.”  Let  us  see 
what  Laennec  said  touching  the  same  sign  some  eighteen  years  be- 
fore. According  to  this  writer,  that  variety  of  the  dry  sibilous  rhon- 
chus  which  is  “ more  strictly  sibilous,  is  probably  occasioned  by  a 
local  contraction  of  the  smaller  bronchi,  from  thickening  of  their  in- 
ner membrane.”  This  short  sentence  is  the  key  note  on  which  Dr. 
Latham  rings  the  amplifications  which  he  ushers  in  with  the  modest 
“ I am  not  sure  that,”  “ I doubt  whether,”  until  he  arrives  at  Laennec 
and  the  root  of  the  matter  with  his  “ it  may  undergo  wrinklings,  or 
puckerings,  at  various  spaces,  or  its  general  tumefaction  may  produce 
a narrowing  of  the  smaller  tubes.”  Proceeding  to  illustrate  the  said 
sibilus  still  further,  he  describes  the  case  of  a little  boy,  in  whose 
chest  a shrill  sibilus  had  taken  place  of  the  natural  respiratory  mur- 
mur,— “ Wherever  you  applied  your  ear  to  the  chest,  you  might  fancy 
you  heard  the  piping  and  screaming  of  a nest  of  unfledged  birds.” 
How  delightfully  this  simile  is  brought  in  as  a new  and  felicitous  illus- 
tration  with  the  “ you  might  fancy and  how  poetically  has  he  deco- 
rated the  dry,  matter  of  fact,  detail  of  Laennec,  who  writes — “ The 
dry  sibilous  rhonchus  is  of  very  various  character.  Sometimes  it  is 
like  a prolonged  whistle,  flat  or  sharp,  dull  or  loud ; sometimes  it  is 
very  momentary,  and  resembles  the  chirping  of  birds.”  Truly,  Dr. 
Latham  deserves  credit  for  his  ingenuity.  It  would  be  amusing 
enough  to  show,  page  by  page,  how  dexterously  the  Bartholomew  pro- 


TREFACE. 


25 


fessor  twists  Laennec  into  a new  shape.  Sometimes  he  swells  a 
few  words  into  a mass  of  well-rounded  periods ; at  others,  he  reverses 
the  process,  and  compresses,  with  crushing  effect  as  to  sense  and  infor- 
mation, a series  of  nicely  evolved  deductions  into  a few  disjointed 
sentences.  In  fact,  he  lias  put  Laennec  into  his  literary  mill,  ground 
him  down,  and  then  leavened  him  with  his  own  leaven,  with  that  pe- 
culiar skill  in  the  process  which  might  excite  the  envy  of  a “ book- 
seller’s hack.”  His  art  in  appropriating  good  things  is  only  to  be 
equalled  by  his  aptitude  to  spoil  them  while  in  the  act  of  “ conveying.’’ 

Dr.  Latham  is  equally  guiltless  with  his  comates  of  enlarging  the 
boundaries  of  science ; and  is  also  equally  anxious  to  announce  his 
want  of  success  in  the  treatment  of  consumptive  disease.  He  has 
very  whsely  devoted  a volume  to  show  the  marvels  he  can  achieve  by 
means  of  auscultation,  with  what  precision  he  can  calculate  the  rava- 
ges of  the  disease,  and  O ! the  art  of  sinking, — how  utterly  unable 
he  is  to  cope  with  it.  “ All  the  world,”  he  exclaims,  “ is  asking  us 
whether  consumption  be  curable’’'’  (sic  in  original.)  Indeed!  It  has 
come  to  this,  has  it?  I am  personally  obliged  by  the  confession. 
Dr.  Latham  has  now  only  one  more  step  to  make,  and  he  will  dis- 
cover some  fine  morning  that  consumption  is  curable.  The  pressure 
from  without  will  jog  him  and  his  brethren  on.  All  the  world  asks 
the  question  ! This  coincides  with  my  own  opinion ; and  I find  peo- 
ple come  a long  way  to  ask  it.  I have  had  individuals  of  this  in- 
quisitive turn  of  mind  who  have  come  from  Sweden,  from  Russia, 
from  both  the  East  and  West  Indies,  and  from  other  distant 
quarters,  to  ask  the  aforesaid  question,  and  they  were  satisfied  wdth 
my  answer  ; although  I must  think  they  would  have  repented  their 
trouble  had  I given  them  Dr.  Latham’s. 

Dr.  Latham  is  much  more  elaborate  than  his  non-curing  coadjutors, 
in  displaying  his  disbelief  of  the  curability  of  consumption.  He  rea- 
sons ! at  some  length  on  this,  to  these  gentlemen,  all-important 
point.  So  eager  indeed  are  the  trio  to  prove  to  their  patients  their 
inability  to  cure  consumption,  that  I verily  believe  they  would  willing- 
ly contract  the  disease,  were  it  possible,  and  die  in  order  to  support 
their  doctrine.  They  would  be  cheerful  martyrs  to  their  professional 
faith,  and  perish  honourably  secundum  arlem. 

But  to  return  to  Dr.  Latham’s  reasoning.  It  is  so  exquisite  a thing 
of  the  kind,  that  I should  do  him  injustice  were  I not  to  give  it  in 
his  own  words.  In  examining  by  dissection  the  bodies  of  those 
who  die  of  pulmonary  consumption  we  occasionally  find  the  traces 
of  a vomica  healed.  But  in  those  who  have  not  died  of  any  pulmo- 
nary symptoms,  (die  of  symptoms  !)  and  who  were  never  known 
during  their  lives  to  have  any  symptoms  apparently ; the  same  evi- 
dences have  been  found  after  death  of  what  was  once  a vomica. 
This  is  a cure,  or  tantamount  to  a cure,  but  it  was  a consumption 
which  nobody  knew  to  exist.”  Proceeding  then  to  the  question  which 
he  describes  all  the  world  to  he  asking,  he  rejoins,  “ It  is  a mockery 
to  answer,  ‘ Consumption  is  a curable  disease  ;’  because,  forsooth,  its 
entire  process  from  beginning  to  end — its  formation,  progress,  cure — 
may  be  secretly  transacted  within  the  body  without  our  knowing,  or 
suspecting  any  thing  about  it.”  This  is  superlative.  I meet  a person 
whose  face  is  seamed  with  the  scars  left  by  small  pox,  and  because  I 

4 


26 


PREFACE. 


did  not  see  him  when  labouring  under  the  disease,  1 deny  that  he  evez 
had  it.  I am  in  company  with  another  who  has  lost  an  eye,  and  be- 
cause I did  not  witness  the  loss,  I assert  that  it  is  in  his  head.  A pa- 
tient dies,  as  is  supposed,  of  eruptive  fever,  for  which  he  has  been 
treated,  but  dissection  proves  that  pneumonia  was  the  more  immediate 
cause  of  death  ; still  as  the  pneumonia  was  not  discoverable  during 
life — ergo,  says  Dr.  Latham,  exist  it  did  not.  In  short,  according  to 
this  writer’s  newly  invented  logic,  there  can  be  no  such  thing  as  latent 
disease  because  it  is  “ secretly  transacted  within  the  body,”  and  as  be 
ingenuously  adds,  “ without  our  knowing  or  suspecting  any  thing 
about  it” — a circumstance  which  an  ordinary  man  would  suppose 
implied  in  the  word  secretly. 

Should  we  be  rash  enough  to  affirm  that  Dr.  Latham  exists  without 
brains,  because  no  traces  of  them  are  at  present  discernible  ? Far 
from  us  be  such  rigid  logic — we  will  not  test  the  doctor  by  his  own 
rule. 

Did  I leave  the  above  quotations  from  Dr.  Latham’s  work  as  they 
now  stand,  I should  act,  as  Dr.  Latham  has  done  by  the  question  at 
issue,  most  disingenuously.  I will  quote  his  special  pleading  verbatim 
et  literatim,  and  give  him  all  the  benefit  of  it.  By  the  abstract  made 
above,  every  word  of  whieh  is  his,  although  separated  from  the  con- 
text, I have  been  enabled  to  show  the  naked  folly  of  his  reasoning. 
The  context  will  render  manifest  either  his  disingenuousness,  or,  if  writ- 
ten in  good  faith,  his  ignorance. 

“ Does  consumption  ever  admit  of  cure  ? If  ever,  it  must  surely 
be  when  it  occurs  in  the  form  which  we  are  now  considering,  i.  e. 
in  the  form  termed  by  Dr.  Latham  unmixed  phthisis.  Let  us,  there- 
fore, now  give  a few  moments  to  this  interesting  question.  A vomica 
certainly  does  admit  of  reparation  so  far  as  not  to  be  a vomica  any 
longer,  but  not  so  far  as  to  leave  behind  it  no  trace  within  the  lungs. 
It  leaves  behind  it  a scar — that  is,  the  disease  ceases  in  the  part,  but 
the  par  tis  not  restored  to  the  exact  condition  in  which  it  was  before 
the  disease  began.  In  examining  by  dissection  the  bodies  of  those 
who  die  of  pulmonary  consumption,  among  many  existing  vomic2e 
we  occasionally  find  the  traces  of  a vomica  healed.  At  the  apex  of 
the  lung  we  find  an  indentation,  and  descending  from  it,  for  half  an 
inch  or  an  inch,  a thick  perpendicular  line  of  tough  ligamentous  sub- 
stance. Sometimes  this  substance,  by  being  pulled  asunder,  is  discov- 
ered to  contain  the  remains  of  a cavity,  and  sometimes  not.  But 
what  imports  this  reparation  of  a single  vomica,  if  so  many  besides 
still  exist  ? A reparation  of  a twentieth  part  of  the  existing  disease 
cannot  be  called  a cure.  But  in  those  who  have  not  died  of  any  pul- 
monary symptoms,  and  who  were  never  known  during  their  lives  to 
have  had  any  symptoms  apparently  phthisical,  the  same  evidences 
have  been  found  after  death  of  what  once  was  a vomica,  but  no  ex- 
isting vomica  together  with  it.  This  is  a cure,  or  tantamount  to  a 
cure.  It  is  as  much  a cure  as  when  a single  scrofulous  cervical  gland 
goes  on  to  suppuration,  and  heals  with  a scar.  A single  vomica,  you 
may  say,  is  as  much  of  the  essence  of  consumption  as  a hundred ; 
and  if  the  morbid  structure  (no  matter  how  small)  in  which  the  dis- 
ease essentially  consists  be  repaired,  the  disease  is  cured  ; that  is,  the 
consumption  is  cured.  But  it  was  a consumption  nobody  knew  to 


PREFACE. 


27 


exist.  Now  all  this  may  be  very  fine  reasoning  ; but  it  does  not  meet 
the  plain  meaning  of  the  inquiry,  whether  consumption  be  curable. 
It  is  not  proof  enough  to  common  sense  of  its  being  so,  that  a few 
isolated  vomicae,  which  gave  no  sign  of  their  existence,  should  have 
undergone  reparation.  All  the  world  is  asking  us  whether  consump- 
tion be  curable?  Indeed,  all  the  world  is  interested  in  the  question  : 
for  there  is  hardly  a family  into  which  consumption,  sooner  or  later, 
does  not  enter  : and  when  a man  makes  the  inquiry  (as  it  were)  spec- 
ulatively, or  indifferently,  he  has  most  likely  a real  practical  interest 
in  it  at  home.  He  says,  ‘ Is  consumption  a curable  disease?’  But 
he  would  say,  ‘ I have  a wife  or  a child,  a brother  or  a sister,  who  is 
decidedly  consumptive ; is  there  the  least  possible  hope  left  me  that 
they  can  recover  ?’  To  the  question  proposed  with  such  intent,  it  is  a 
mockery  to  answer,  ‘ Consumption  is  a curable  disease  because,  for- 
sooth, its  entire  process  from  beginning  to  end — its  formation,  progress 
cure — may  be  secretly  transacted  within  the  body  without  our  know- 
ing or  suspecting  any  thing  about  it.  If  you  ask  me,  as  a physician, 
whether  I have  ever  had  experience  of  a perfect  and  satisfactory  re- 
covery taking  place,  where  there  have  been  all  the  best  known  popular 
symptoms,  which,  as  far  as  they  go,  no  physician  could  possibly  say 
were  not  those  of  phthisis?  I answer,  ‘ Often.’  But  if  you  ask  me 
whether  I have  ever  had  experience  of  the  like  perfect  and  satisfactory 
recovery  where  there  were  all  these  popular  symptoms,  and,  withal, 
the  conditions  proper  to  phthisis,  ascertained  by  auscultatory  signs  to 
exist  beyond  a doubt  within  the  lungs  ? I answer,  ‘ Hitherto,  never.’ 
What  shall  we  say  then  ? How  shall  we  answer  the  popular  question 
in  the  popular  sense,  and  still  answer  it  truly?  We  cannot  say  that 
consumption  is  curable  ; but  we  can  say,  and  truly,  that  there  are 
cases  of  imputed  consumption  which  put  on  such  an  aspect  of  the 
real  disease,  that  they  are  with  difficulty  distinguished  from  it,  yet 
have  not  its  essence.  These  are  all  within  the  possibility  of  cure,” 
p.  254,  et  seq.  The  chain  of  reasoning,  such  as  it  is,  in  the  above,  is 
substantially  the  same  as  in  the  abstract  first  given — its  gist  being  the 
consoling  discovery  that  whatever  we  are  ignorant  of  does  not  exist. 
But  there  is  this  addition ; that  traces  of  a healed  vomica  are  said  to 
be  found  among  existing  vomicce  in  the  bodies  of  those  who  die  of 
pulmonary  consumption,  but  to  exist  in  a solitary  state  when  ocurring 
in  those  who  were  never  known  during  their  lives  to  have  had  any 
symptoms  apparently  phthisical.  The  interpretation  designed  by  the 
doctor  to  be  put  on  this  statement  is,  of  course,  that  the  vomica  in  the 
one  case  belongs  to  real  consumption,  and  in  the  other  is  accidental. 

In  Dr.  Clark’s  treatise,  I find  so  apt  an  illustration  of  one  probable 
cause  of  Dr.  Latham’s  egregious  errors,  (and,  indeed,  of  his  own  lim- 
ited views,)  that  I am  tempted  to  transcribe  it.  He  observes,  “ It  often 
happens  that  a patient,  presenting  all  the  indications  of  tuberculous 
disease,  is  said,  and  believed  to  be,  merely  threatened  with  disease  of 
the  lungs,  or  to  have  an  affection  of  the  trachea  or  bronchi ; and  it  is 
commonly  added  that  ‘ with  care  all  will  do  well.’  This  arises  from 
the  habit  of  trusting  to  symptoms  alone  for  a knowledge  of  disease, 
neglecting  pathological  anatomy,  by  which  the  physician  is  enabled  to 
connect  the  external  phenomena  of  disease  with  the  morbid  condition 
of  the  organ.” 


28 


PREFACE. 


Even  were  the  facts  as  Dr.  Latham  states,  his  inferences  would  be 
supremely  absurd  ; but  being  utterly  unsupported  by  the  results  of 
dissection,  they  must  be  put  forward  either  designedly  or  ignorantly. 
To  appeal  to  my  own  experience  only  would  be  to  rebut  assertion  by 
assertion.  I shall  therefore  adduce  proof  of  this  accusation  from  the 
pages  of  Laennec,  Andral,  and  Louis. 

Dr.  Latham  has  indeed  found  it  convenient  to  copy  Laennec  in  all 
save  his  conclusions,  to  which  I shall  presently  draw  his  attention. 
However,  I shall  first  quote  Laennec’s  remarks  on  the  cases  he  de- 
scribes in  his  chapter  on  phthisis  pulmonalis  : for  the  cases  them- 
selves, I must  refer  the  reader  to  his  “ Traitd  de  V Auscultation  Me- 
diated’ He  writes  then  as  follows : “ In  my  opinion,  the  foregoing 
cases  prove  that  tubercles  in  the  lungs  are  not  in  every  case  a neces- 
sary and  inevitable  cause  of  death,  and  that  after  an  ulcerous  exca- 
vation has  been  formed  by  their  softening  down,  a cure  may  take 
place  in  two  ways  : in  one,  by  the  conversion  of  the  ulcer  into  a fis- 
tula, lined,  like  all  those  which  may  exist  without  injuring  the  gene- 
ral health,  by  a membrane  analagous  to  the  tissues  of  the  healthy 
body ; in  the  other,  by  means  of  a cicatrix,  more  or  less  complete, 
and  consisting  of  cellular,  fibro-cartilaginous,  or  semi-cartilaginous 
substance.  The  identity  of  the  cavities  recorded  in  the  19th,  20th, 
21st,  22d,  and  24th  cases,  leaves  no  doubt  as  to  the  similarity  of  their 
origin,  and  their  production  by  the  softening  of  tubercles  which  had 
occupied  their  place.  The  19th  case  may  be  looked  upon  as  a cure, 
since  no  more  tubercles  existed  in  the  lungs.  The  same  may  be  said 
of  the  25th,  since  there  was  hut  one  small  tubercle  met  with.  The  sub- 
jects of  the  20th,  21st,  and  22d  cases  would  undoubtedly  have  under- 
gone relapses,  since  there  were  crude,  or  miliary  tubercles  in  their 
lungs  which  must  have  been  subsequently  developed ; although  this 
might  have  been  protracted  to  a late  period,  and  have  still  left  the 
hope  of  a long  life.  It  has  been  truly  remarked  by  Bayle  that  crude, 
and  in  particular  miliary  tubercles,  often  exist  for  a series  of  years 
without  seriously  affecting  the  health.”  A little  further  on  he  writes, 

“ Pulmonary  fistulse  and  cicatrices  are  extremely  common  * * * * no 
one  can  follow  a six  months’  course  of  pathological  anatomy  without 
meeting  with  them.”  (Vol.  ii,  pp.  98,  99,  100.)  Will  the  learned 
professor  at  Bartholomew’s  step  forward  with  his  “ we  occasionally 
find,”  and  deny  this — Latham  versus  Laennec  ? 

The  doctor  has  indeed  very  coolly  reversed  the  order  of  Laennec’s  • 
reasoning.  He  infers,  as  has  been  seen,  that  since  cicatrizations  are 
found,  at  one  time,  combined  with  cavities  and  tuberculous  deposites 
in  the  lungs  of  those  who  have  exhibited  symptoms  of  phthisis,  and, 
at  another,  without  these  adjuncts  in  the  lungs  of  those  who  are  said 
not  to  have  betrayed  such  symptoms,  the  cicatrices  in  the  last  are 
lusus  naturcBf  chance  creations,  “ delusions  of  the  evil  one.”  Now 
Laennec  argues  thus : “ Notwithstanding  I have  found  tubercles,  in 
different  stages  of  development,  in  most  lungs  that  have  presented 
pulmonary  fistulas  or  cicatrices,  which  would  presume  the  certain,  al- 
though perhaps  remote  return  of  the  disease  ; yet,  as  in  cases  19  and 
25,  I have  likewise  frequently  met  with  the  same  marks  of  cure  in 
subjects  who  have  been  entirely  free  from  tubercles  in  the  lungs  or 
any  other  organ.  In  such  cases  it  may,  perhaps,  be  supposed  that 
tho  cicatrices  result  from  abscesses  produced  by  inflammation  of  the 


PREFACE. 


29 


lungs,  and  not  from  tubercles.  Such  a supposition,  however,  would 
be  perfectly  gratuitous.  Whoever  is  in  the  habit  of  constant  post-mor- 
tem examinations,  may  trace  day  by  day,  as  it  were,  the  formation  of  the 
semi- cartilaginous  membrane  on  the  surface  of  tuberculous  cavities ; 
but  the  production  of  a collection  of  pus,  or  of  a true  abscess  in  the 
lungs  by  inflammation,  although  not  an  impossibility,  is  yet  so  rare 
as  to  be  utterly  insufficient  to  account  for  so  common  an  occurrence.” 
(Vol.  ii,  pp.  104,105.)  Dr.  Latham  andLaennec  are  thus  at  issue  both 
as  to  facts  and  as  to  inferences  from  those  facts.  It  does  not  require 
the  technical  knowledge  of  the  practitioner  to  decide  between  them. 
The  common  sense  of  the  general  reader  may  be  safely  intrusted 
with  the  delivery  of  the  verdict. 

The  conclusions  drawn  by  Laennec  from  the  experience  of  his  vast 
practice,  from  his  pathological  investigations,  and  from  the  extensive 
field  of  observation  laid  open  by  his  immortal  discovery,  are  passed 
over  by  Dr.  Latham  ; or  rather,  are  flatly  contradicted  by  the 
‘‘  learned  Theban.’’  This,  too,  as  in  the  case  of  Drs.  Clark  and 
Davies,  is  the  more  astounding,  as  Laennec  has  furnished  the  staple 
of  his  book.  However,  “ majora  canamus^^ — Laennec  thus  sums  up  : 
“ I here  conclude  what  I had  to  say  on  the  possibility  of  curing  pul- 
monary phthisis  ; and  trust  the  importance  of  the  subject  will  excuse 
the  length  of  my  observations.  With  regard  to  the  facts  I have 
brought  forward  to  prove  its  curability,  I am  convinced  that  every 
attentive  observer  will  frequently  meet  analagous  ones  by  employing 
the  same  means — mediate  auscultation  and  dissection.  My  experience 
makes  me  believe  them  to  be  extremely  common.  I met  with  the 
cases  I have  adduced  in  the  course  of  a few  months  ; I have  since 
seen  many  others  in  the  same  period  ; and  it  appears  to  me  much 
more  rational  to  refer  this  to  their  frequency  than  to  my  having  by 
chance  fallen  upon  such  a collection  of  cases  that  are  naturally  rare. 
I have  mentioned  my  having  often  observed  similar  appearances  for- 
merly, without  paying  much  attention  to  them  ; as  in  the  natural 
sciences,  an  object  may  be  daily  seen  and  yet  remain  unknown,  un- 
less our  notice  be  particularly  directed  to  it.  A gardener  is  seldom 
acquainted  with  a tenth  part  of  the  plants  growing  in  the  very  ground 
he  cultivates  ; and,  to  borrow  a comparison  from  medical  science  it- 
self, an  anatomist  may  be  utterly  ignorant  of  the  organic  changes 
which  occur  in  the  human  body,  notwithstanding  he  sees  them  every 
day  while  tracing  the  blood-vessels,  or  the  nervous  filaments.  From 
my  own  experience  I can  affirm  that  a man  in  the  daily  habit  of 
opening  dead  bodies  may  nevertheless  partly  forget  descriptive  anato- 
my. To  conclude,  the  cure  of  consumption,  when  the  lungs  have  not 
been  entirely  disorganized,  ought  not,  1 think,  to  be  considered  at  all 
impossible,  either  as  regards  the  nature  of  the  disease,  or  of  the  organ 
affected.  Pulmonary  tubercles  are  in  no  wise  different  from  those 
found  in  scrofulous  glands  ; the  softening  of  which  is,  we  know,  often 
followed  by  a cure.  On  the  other  hand,  the  destruction  of  a part  of 
the  substance  of  the  lungs  is  not  necessarily  mortal ; since  even  wounds 
of  this  organ  are  frequently  healed,  notwithstanding  their  distressing 
complication  with  the  perforation  of  the  walls  of  the  chest,  and  the 
admission  of  air  into  the  pleura.”  (Vol.  ii,  pp.  110,  111,  112.) 

To  illustrate  the  difference  between  the  candid  allowances  made  by 


30 


PREFACE. 


a man  of  genius,  even  when  his  experience  has  been  contrary  to  the 
existence  of  a reported  fact,  and  the  supercilious  gainsayings  ©f  a 
sciolist,  I cannot  do  better  than  quote  the  following  admission  made 
by  Louis.  He  is  closing  his  remarks  on  a case  in  which  he  had  met 
with  an  excavation  of  middle  dimensions,  lined  by  a false  membrane 
of  moderate  consistence,  a quarter  of  a line  in  thickness,  and  lying 
upon  healthy  pulmonary  tissue  : “ But  may  it  not  be  asked,  with  some 
show  of  probability,  whether  this  excavation  were  really  the  product 
of  tubercles  and  if  the  patient  had  phthisiSf  since  no  tubercles  or  gray 
granulations  existed  in  the  lungs  ; and  there  were  no  ulcerations  in 
the  larynx,  trachea,  or  intestines — alterations  of  such  frequent  occur- 
rence in  this  affection  ? To  this  I would  reply,  that  the  purulent 
matter  of  the  excavation  was  identical  with  that  commonly  found  in 
tuberculous  cases  ; that  the  false  membrane  had  equally  analagous 
properties  ; lastly,  and  the  fact  is  a powerful  one,  a cervical  gland 
was  evidently  tuberculous : and,  in  the  course  of  these  researches,  it 
will  be  seen  that  I have  never  met  with  the  tuberculization  of  lym- 
phatic glands,  except  in  the  consumptive.  * * * * To  conclude  what 
I have  to  remark  on  the  subject  of  tuberculous  excavations,  I may  add, 
that  I have  not  met  in  a single  instance  with  cavities,  surrounded  by 
healthy  pulmonary  parenchyma,  communicating  with  the  bronchi, 
and  lined  with  a light  gray,  semi-cartilaginous,  semi-opaque  false 
membrane,  as  tuberculous  excavations  of  long  standing  are.  M.  La- 
ennec,  however,  has  found  them  in  subjects  who  had  presented  the 
symptoms  of  phthisis  during  life,  for  a longer  or  shorter  time.  Judg- 
ing, too,  from  their  structure,  it  would  be  difficult  not  to  believe  that 
their  formation  was  preceded  by  tuberculous  softening.  This  fact, 
indeed,  receives  confirmation  from  the  foregoing  case ; since,  in  this, 
as  well  as  in  the  other  cases  to  which  I allude,  there  was  only  a solitary 
excavation  ; the  substance  of  the  lungs  was  healthy  ; and  it  may  be 
concluded  that  if  the  indiuidiial’s  life  had  been  prolonged  for  some 
weeks,  or  months,  the  false  membrane  which  lined  the  cavity  would 
have  presented  the  above-mentioned  characters.” 

How  different  this  from  the  animus,  how  widely  different  from  the 
reasoning  powers  of  the  man  who  writes,  ‘‘  but  it  was  a consumption 
which  nobody  knew  to  exist.”  How  opposite  the  spirit  of  the  patient 
searcher  after  truth,  and  of  the  sophist  who  seeks  to  quibble  it  away. 
Thus  we  have  Dr.  Latham  versus  Louis ! 

Proceeding  now  to  the  author  from  whom  Dr.  Latham  has  taken 
the  best  point  in  his  argument,  I will  give  him  an  answer,  drawn  from 
the  same  source,  to  his  “ consumption  which  nobody  knew  to  exist.” 
Andral  then  writes  as  follows  : “Looking  collectively  at  the  facts  now 
cited,  the  result  would  seem  that  cavities  of  greater  or  less  size,  which 
have  at  some  period  existed  in  the  pulmonary  parenchyma,  may  at 
times  perceptibly  diminish,  and  even  be  completety  obliterated. 
Laennec  has  described  excellently  the  progress  of  this  obliteration  ; 
and  this  being  a well- ascertained  fact,  the  question  may  arise  as  to 
whether  they  were  tuberculous  excavations.  To  this  we  may  answer  in 
the  affirmative.’^  (Andral,  Clinique  M^dicale.)  The  point  which  I 
have  just  said  Dr.  Latham  has  conveyed  from  his  author  is  founded 
on  the  assumed  fact  that  cicatrizations  are  generally  observed  existing 
simultaneously  with  tuberculous  deposites  ; from  which  Andral  infers 


PREFACE. 


31 


“ we  must  not  confound  the  certain  cure  of  a cavity  with  the  cure 
of  the  tuberculous  aftection  itself.”  This  is  converted  by  Dr.  Latham 
into  the  similar,  but  exaggerated  proposition — “ What  imports  this 
reparation  of  a single  vomica,  if  so  many  besides  still  exist  % A repa- 
ration of  a twentieth  part  of  the  existing  disease  cannot  be  called  a 
cure.’’  Had  he  stopped  at  this  conversion  it  would  have  been  wise. 
But  he  must  improve  it  by  his  discovery,  in  the  first  place,  that  the 
consumption  in  such  cases  is  not  known  to  exist ; and,  in  the  second, 
by  his  still  greater  discovery  that  whatever  is  unknown  does  not  exist. 
This,  indeed,  is  the  doctrine  of  the  materialists  ; and  a sorry  one  it  is. 

Dr.  Latham  I have  already  answered.  In  reply  to  Andral’s  more 
feasible  reasoning  it  is  sufficient  to  observe,  that  if  a single  tubercle 
may  be  cured,  the  same  process  may  obliterate  an  indefinite  number. 

It  may  be  urged  that  I have  misunderstood  or  misrepresented  Dr. 
Latham’s  argument ; that  he  does  not  deny  the  existence  of  consump- 
tion in  the  cases  in  question,  but  our  knowledge  of  its  existence. 
What  then  becomes  of  auscultation  ? Or  does  he  argue  that  because 
a case  is  cured  unknown  to  us,  a cure,  under  similar  circumstances  of 
affection,  can  never  be  effected  with  our  knowledge,  or  by  our  guid- 
ance ! I inquire  of  the  learned  professor  by  what  means  the  science 
of  medicine  has  arrived  at  its  present  state.  Is  it  by  seeking  in  the 
dead  body  for  an  explanation  of  what  has  been  going  on  in  the  living  ? 
And  if  so,  to  what  end  is  this  investigation  instituted  ; to  learn  the 
means  of  cure  by  what  we  see,  or  to  reject  the  lesson  oftered  by  na- 
ture as  an  insult  to  art  ? 

I had  previously  shown  that  his  facts  were  untenable.  I have  now, 
I trust,  proved  that  his  arguments,  understood  in  any  sense,  and  with 
every  advantage  of  quibbling  to  boot,  are  equally  groundless.  How- 
ever, he  is,  I dare  say,  correct  in  one  particular — his  want  of  success 
in  consumptive  cases. 

I have  entered  at  this  length  into  a consideration  of  the  three  writers 
who  have  published  since  the  first  edition  of  my  “ Consumption  Cura- 
ble,” not  from  any  weight  I attach  to  their  authority,  or  from  any 
doubt  of  the  validity  of  my  own  doctrines,  but  from  a sense  of  duty. 
They  would  contract;  I would  enlarge  the  boundaries  of  science. 
Their  opinions  are  at  variance  with  the  positive  testimony  of  patho- 
logical anatomy  ; mine  in  accordance  with  it.  They  belie  the  art 
they  practise  ; I give  it  all  honour.  They-refuse  hope  to  the  sufferer ; 
I certainly  would  not  awaken  it  in  vain,  but  as  certainly  should  deem 
it  criminal  to  crush  it  when  its  realization  is  countenanced  by  nature, 
and  effectuable  by  art. 

It  must  be  startling  to  the  non-medical  reader,  at  least,  to  be  assured 
that  it  is  next  to  an  impossibility  to  open  a dozen  bodies  without  meet- 
ing with  positive  proof  of  the  curability  of  consumption.  Such,  how 
ever,  is  the  fact.  Yet  here  are  three  gentlemen,  it  will  be  urged,  phy- 
sicians of  some  standing  and  of  decent  repute,  Drs.  Clark,  Davies, 
and  Latham,  each  of  whom  too  is  attached  to  some  public  institution, 
who  positively  deny  that  this  disease  can  be  cured.  Is  it  to  be  sup- 
posed that  if  the  proofs  furnished  by  dissection  be  so  common,  they 
have  never  met  with  them  ? To  this  it  may  be  answered,  that  there 
are  few,  very  few  medical  men  who  trouble  themselves  to  open  bodies, 
and  that  not  a tithe  of  these  few  rigorously  examine  them.  I might 


32 


PREFACE. 


rest  my  case  here,  and  the  really  scientific  would  fully  understand  me* 
But  to  bring  conviction  home  to  the  general  reader,  who  might  ima- 
gine I was  merely  opposing  theoretical  opinions  by  theory  of  my  own, 
I shall  bring  forward  the  testimony  of  a gentleman,  frequently  eulo- 
gized by  Dr.  Clark  and  late  medical  writers,  who  is,  1 imagine,  as 
eminent  a pathologist  as  any  in  this  country — no  excessive  praise  by 
the  by — and  who,  though  he  has  not  added,  that  I am  aware  of,  to  our 
stock  of  knowledge,  has  at  least  reported  truly  the  appearances  with 
which  his  dissections  have  made  him  acquainted.  Dr.  Carswell,  then, 
writes  as  follows  : — 

“ The  important  fact  of  the  curability  of  the  disease  has,  in  our  opin- 
ion, been  satisfactorily  established  by  Laennec.  All  the  physical  signs 
of  tubercular  phthisis  have  been  present,  even  those  which  indicate 
THE  EXISTENCE  OF  AN  EXCAVATION,  yet  the  disease  has  terminated  fa- 
vourably, and  its  perfect  cure  has  been  demonstrated  by  the  presence  of 
a cicatrix  in  that  portion  of  the  lung  in  which  the  excavation  had  for- 
merly existed.  * * * * There  must  be  few  practical  pathologists  who 
will  not  consider  these  anatomical  facts  as  evidence  that  tuberculous 
phthisis  is  a curable  disease.  No  objection  has  been  brought  forward 
calculated  in  the  slightest  degree  to  invalidate  the  conclusion  to  which 
we  have  been  led  by  the  repeated  observation  of  the  changes  we  have 
described,  viz:  that  these  changes  are  positive  indices  of  the  re- 
moval of  the  material  element  of  the  disease,  and  also  of  the  cure  of 
the  lesions  of  structure  to  which  it  gives  rise,  even  at  an  advanced 
period  of  its  progress.  * * * * We  cannot  avoid  repeating  the  factj 
that  pathological  anatomy  has,  perhaps,  never  afforded  more  conclusive 
evidence  in  proof  of  the  curability  of  a disease  than  it  has  in  that  of 
tubercular  phthisis.^’ — Cyclopaedia  of  Practical  Medicine,  Art.  Tuber- 
cle, pp.  265,  266,  267. 

In  order  to  give  the  general  reader  a clue  by  which  he  may  un- 
ravel some  of  the  workings  of  our  medical  press,  I subjoin  the  follow- 
ing anecdote.  Dr.  James  Johnson,  editor  of  the  Medico-Chirurgical 
Review,  sent  some  few  months  since  a medical  work  lately  published 
in  Germany  to  Dr.  Spillan,  a contributor  to  the  above  periodical,  beg- 
ging him  to  furnish  a review  and  analysis  of  its  contents.  Dr.  Spil- 
lan, of  course,  proceeded  to  his  task,  and  at  first  conceived  the  work 
to  be  full  of  promise  for  his  purpose,  but  was  perplexed  to  find,  on 
further  reading,  that  the  German  physician  advocated  in  the  strongest 
terms  the  views  and  plan  of  treatment  laid  down  by  Dr.  Ramadge,  of 
London.  For  further  illustration,  the  German  reader  was  referred  to 
the  translation  of  “Consumption  Curable,”  as  to  a publication  well 
known  throughout  Germany.  This  put  the  climax  to  Dr.  Spillan’s 
perplexity  ; and  it  was  quietly  resolved  that  it  would  be  the  more  pru- 
dent plan  to  give  no  notice  of  the  work. 


INTRODUCTION. 


I AM  induced,  from  my  long  connection  with  the  In» 
firmary  for  Asthma,  Consumption,  and  other  diseases  of 
the  Chest,  the  only  institution  of  the  kind  in  this  coun- 
try, and,  as  far  as  I have  been  able  to  ascertain,  in  Eu- 
rope, to  publish  my  opinions  on  the  treatment  of  pulmo- 
nary consumption — a disease  unfortunately  too  well 
known  to  the  inhabitants  of  this  clime,  by  its  prevalence 
and  fatality.  Having  been  thus  for  above  fifteen  years 
placed  in  a situation  which  has  given  me  unrivalled  op- 
portunities of  seeing  numerous  cases  of  this  disease,  I 
conceive  it  a duty  I owe  the  public,  through  whose 
philanthropic  aid  the  above  charity  has  been  long  and 
liberally  supported,  to  present  them  with  the  fruits  of 
my  labours,  and  unreservedly  to  state  how  far  medical 
art  is  capable  of  arresting  a disease  to  which  nearly  one- 
third  of  the  adult  population  falls  a sacrifice. 

The  results  which  have  hitherto  attended  the  treat- 
ment of  phthisis  have  added  but  little  to  the  reputation 
of  the  medical  profession.  I am  fully  satisfied,  however, 
from  the  experience  of  years  in  treating  this  import- 
ant malady,  as  well  as  from  the  deductions  of  unremit- 
ting pathological  research,  that  it  is  in  our  power  to  adopt 
a line  of  practice  more  scientific  and  successful  than 
any  hitherto  employed. 

Though  great  attention  has  been  bestowed  by  several 
distinguished  continental  writers,  especially  by  Laennec, 
Andral,  and  Louis,  on  the  physical  signs  and  morbid  ap- 
pearances of  consumption,  and  notwithstanding  cases 
have  been  minutely  detailed  by  them  in  which  nature 
has  effected  a cure,  still  they  seem  to  me  to  have  had 
little  idea  that  we  can  do  more  than  relieve  indica- 
tions purely  symptomatic. 

A modern  writer  on  consumption  in  this  country,  the 
late  Dr.  Young,  of  St.  George’s  Hospital,  who  did  not 


34 


INTRODUCTION. 


pay  that  attention  to  morbid  anatomy  so  commendable 
in  onr  Gallic  neighbours,  but  whose  opportunities  of  treat- 
ing the  disease  were  considerable,  favours  us  with  an 
opinion  as  to  its  curability,  which  is  very  discouraging. 
He  says,  It  is  probable  that  without  assistance  not  one 
case  in  a thousand  of  the  disease  would  recover ; and 
with  the  utmost  power  of  art,  perhaps  not  more  than 
one  in  a hundred  will  be  found  curable.”  It  is  my  in- 
tention, in  the  succeeding  pages,  briefly  to  show  that 
this  statement  is  unfounded  in  fact ; and  that  med- 
ical treatment  has,  in  not  a few  instances,  tended  to  pre- 
vent rather  than  advance  recovery.  I trust,  too,  I shall 
demonstrate,  in  the  histories  of  some  of  my  cases,  that 
recovery  has  been  owing,  in  a great  measure,  to  the  su- 
pervention of  some  catarrhal  disease,  occurring  sponta- 
neously, or  which  has  been  contracted,  after  the  failure 
of  remedial  agents,  by  an  apparently  imprudent  expo- 
sure to  cold. 

The  reader  will  probably  learn  with  surprise,  that  no 
inconsiderable  number  of  catarrhal  and  asthmatic  dis- 
orders are,  indeed,  the  sequelae  of  the  disease  which 
forms  the  subject  of  this  work,  more  or  less  perfectly 
cured.  Had  the  learned  doctor  whose  name  I have  re- 
cently quoted  been  at  the  pains  to  investigate  the  pri- 
mary symptoms  of  such  disorders,  he  would  have  found, 
in  many  instances,  that  they  displayed  all  the  common 
symptoms  of  pulmonary  consumption ; and  had  this 
hospital  physician  been  accustomed  to  the  examination 
of  dead  bodies,  he  would  have  discovered,  in  more  than 
one-fourth  of  the  adult  subjects  examined  after  death, 
cicatrizations  indicative  of  cured  consumption  ; and  oi;i 
finding  these  appearances,  had  he  inquired  of  some 
near  relative  of  the  deceased,  if  the  individuals,  at  any 
period  of  their  lives,  had  for  a time  expectorated  blood 
— had  been  troubled  with  indomitable  cough,  night- 
sweats,  diarrhoea,  with  emaciation  of  the  body — or  had 
been  regarded  by  their  medical  attendants  as  consump- 
tive, his  opinion  as  to  the  curability  of  phthisis  would 
probably  have  been  more  favourable. 

It  is,  indeed,  strange  that  medical  men  have  not  no- 
ticed the  non-liability  of  the  asthmatic  individual  to  pul- 
monary consumption;  and  that  various  species  of  ca- 
tarrh are  the  instruments  by  which  nature  chiefly  arrests 


INTRODUCTION. 


35 

that  disease.  It  has  been  observed  by  me  for  years  past, 
and  on  many  occasions  I have  particularly  remarked  to 
my  pupils,  that  asthmatics,  (I  mean  those  persons  whose 
lungs  are  emphysematous,)  however  long  exposed  to  cir- 
cumstances that  favour  the  tubercular  development  in 
the  lungs,  never  become  consumptive.  Indeed,  I have 
long  found,  and  it  is  a remarkable  fact,  that,  whenever 
the  general  health  has  been  impaired  by  some  ailment 
of  a chronic  and  even  incurable  nature,  no  phthisical 
state  supervenes,  (which  is  unhappily  in  too  many  cases 
the  more  immediate  cause  of  death,)  provided  the  individ- 
ual have  a voluminous  and  catarrhal  state  of  the  lungs. 

From  the  numerous  proofs  dissection  has  afforded  me 
of  the  asthmatic  state  of  the  lungs  in  persons,  who, 
having  recovered  from  consumption,  have  died  from 
some  other  cause,  I am  induced  to  recommend  the  early 
employment  of  artificial  means  for  the  healing  of  ulcer- 
ous phthisis.  After  the  careful  examination  of  at  least 
three  thousand  dead  bodies,  and  after  having  had  under 
my  care  many  thousand  consumptive  cases,  my  fixed 
opinion  is,  that  ulcers  of  the  lungs  are  most  effectually 
cured,  and  a fresh  formation  of  tubercles  prevented,  by 
an  expansion  of  the  vesicular  structure  of  the  lungs ; 
which,  it  will  be  seen  hereafter,  is,  in  many  instances, 
brought  on  by  chronic  catarrh.  Before  tuberculous  ex- 
cavations have  taken  place,  and  even  after  their  exist- 
ence has  been  ascertained  by  stethoscopic  signs,  there 
is  an  absence,  except  toward  the  close  of  the  disease, 
of  any  catarrhal  affection,  or  at  least  its  continuance  is 
only  of  short  duration.  I know  this  statement  of  the 
non-existence  of  a catarrhal  state  accompanying  phthi- 
sis is  opposed  to  what  appears  in  the  excellent  work  of 
M.  Laennec  ; but  I am  satisfied  of  its  general  correct- 
ness, and  that  extended  research  will  confirm  my  as- 
sertions. 

Independently  of  the  extensive  experience  obtained 
through  my  situation  in  the  Infirmary  for  Diseases  of 
the  Chest,  I have  enjoyed  the  advantages  afforded  by 
no  inconsiderable  share  of  private  practice,  as  well  as  a 
wide  field  of  inquiry  opened  to  me  for  several  years  at 
the  Central  Infirmary  and  Dispensary,  an  institution  es- 
tablished, and  in  a great  degree  upheld,  at  my  own  ex- 
pense for  all  classes  of  diseases ; and  where,  from  my 


36 


INTRODUCTION. 


being  physician  to  the  first  mentioned  charity,  I had  a 
more  numerous  assemblage  than  is  generally  seen  in 
any  institution  of  a similar  kind  of  patients  affected 
with  some  disease  or  other  of  the  chest. 

It  affords  me  pleasure  to  state,  that  my  practice  at 
both  institutions  has  been  attended  by  numerous  and 
intelligent  classes  of  pupils,  who  had  opportunities, 
equally  with  myself,  of  witnessing  the  recovery  of  many 
consumptive  persons,  and  of  ascertaining  that  peculiar 
condition  of  the  lungs  which  I have  already  pointed 
out  as  invariably  occurring  when  a cure  has  been  effected. 


GENERAL  OBSERVATIONS  ON  CONSUMPTION. 


The  mortality  which  annually  takes  place  in  this 
country  through  consumptive  disease  is  a melancholy 
truism,  although  its  extent,  familiar  as  it  may  appear, 
is  yet  imperfectly  known.  The  ordinary  estimate,  and 
this  as  I shall  subsequently  prove  far  from  an  exag- 
gerated one,  gives  one-fourth  of  the  deaths  yearly  oc- 
curring in  this  ever-varying  climate  as  consequent 
on  pulmonary  consumption  alone.  Dreadful  as  this 
amount  seems,  yet  since,  in  numerous  instances,  patients 
who  have  laboured  under  chronic  diseases,  as  dyspepsia, 
cancer,  severe  diseases  of  the  bones,  joints,  &c.,  or 
any  other  affection  by  which  the  general  system  may 
have  been  deteriorated,  owe  the  immediate  cause  of 
their  death,  not  to  these  complaints,  but  to  the  super- 
vention of  consumption,  it  is  evident  that  the  propor- 
tion of  one-fourth  is  much  lower  than  the  truth.  Again, 
considering  the  frequency  of  cases  in  which  asthmatic, 
or  catarrhal  complaints  arise  in  the  first  instance  from 
consumption,  which,  though  arrested  or  finally  cured, 
occasions  these  very  complaints  as  its  consequences,  I 
may  fairly  assume  that  the  startling  proposition  I have 
laid  down  is  corroborated  by  fact.  To  individuals 
unaccustomed  to  extended  pathological  researches  my 
assertions  will,  at  first  sight,  undoubtedly  appear  rash 
and  hypothetical.  The  pathologist,  who  is  deserving 
of  the  name,  will  either  from  his  own  experience  be 
ready  to  acquiesce  in  my  views,  or  at  least  will  can- 
didly endeavour,  by  further  inquiries,  to  verify  conclusions 
arrived  at  by  the  labours  of  years  ; and  this  at  a sacrifice 
both  of  time  and  money,  which  none  but  the  very  few 
who  cultivate  this  branch  of  science  with  the  zeal  and 
assiduity  its  importance  deserves  are  prepared  to  estimate. 

In  addition  to  the  reasons  I have  just  given,  to  show 
the  inaccurate  statement  presented  by  the  bills  of  mor- 
tality, I could  enumerate  numerous  instances  in  which 


38  OBSERVATIONS  ON  CONSUMPTION. 

the  real,  as  distinguished  from  the  apparent  causes  of 
the  patient’s  death,  would  offer  conclusive  testimony 
to  my  position.  Frequent  are  the  cases  in  which  an 
individual  will  suddenly  expire  after  violent  expecto- 
ration of  blood,  and  his  disease  be  attributed  to  a 
ruptured  blood-vessel,  when  indeed  this  hemorrhage 
has  been  consequent  solely  on  latent  and  unsuspected 
phthisis.  My  readers  must  not  misconceive  me  to 
state,  that  every  case  of  sudden  death  from  spitting  of 
blood  arises  from  the  little-suspected  presence  of  this 
destroyer ; but  that,  in  not  a few  instances,  consump- 
tion is  indisputably  the  pre-existing  cause.  It  were 
easy  to  adduce  further  arguments  corroborative  of  the 
soundness  of  my  conclusions ; but  I have,  I should 
think,  stated  sufficient  to  induce  conviction  of  their 
reasonableness,  if  not  of  their  entire  validity. 

The  first  questions  to  be  considered  are,  to  what  the 
frequency  of  this  disease  is  owing,  how  it  is  produced, 
and  in  what  manner  its  ravages  are  unfortunately  ex- 
tended? The  prevalence  of  consumption  has  long 
been  attributed  to  the  proverbial  variableness  of  our 
climate ; but  the  mode  by  which  this  operates  upon 
the  constitution  has  not  been  clearly  explained.  It 
seems  to  me,  however,  that  the  action  of  the  climate 
on  the  system  may  be  reduced  to  three  distinct  heads, 
each  equally  common,  and  equally  fatal : checked  per- 
spiration, retaining  the  superfluous  humours,  and  thus 
vitiating  the  fluids  of  the  .body — constant  fluctuations 
of  health,  resulting  from  constant  atmospheric  changes 
— and  dejection  of  spirits,  caused  by  mental  troubles. 
To  these  may  be  subjoined  an  unfortunate  configura- 
tion of  the  body,  consisting  in  an  undue  narrowness  of 
the  chest,  especially  in  its  upper  part,  less  observable 
in  foreigners  than  among  ourselves.  It  is  not  neces- 
sary to  dilate  upon  the  process  by  which  checked  per- 
spiration lays  the  foundation  of  this  dreadful  malady ; 
since  it  must  be  evident  to  the  tyro,  that  when  those 
humours  which  pass  off  insensibly  in  a healthy  state 
of  the  body  are  retained,  and  the  natural  functions 
thus  disturbed,  disease  more  or  less  extensive  will  in- 
evitably ensue.  With  respect  to  the  second  of  these 
heads,  it  may  to  the  ordinary  observer  appear  super- 
fluous to  insist  upon  the  ill  effects  generated  by  con- 


OBSERVATIONS  ON  CONSUMPTION.  39 

stant  change  of  weather,  in  persons  not  only  of  delicate 
but  even  of  robust  habits  ; still,  obvious  as  these  effects 
are,  it  is  not  quite  so  apparent  in  what  they  consist,  or 
rather  how  they  are  produced.  Now,  when  we  take 
into  consideration  the  peculiarly  delicate  conformation 
of  the  lungs,  and  their  immediate  susceptibility  of 
every  alteration  in  the  atmosphere,  we  at  once  arrive 
at  a resolution  of  the  question.  It  is  essential,  in  or- 
der to  maintain  a healthy  action  and  proper  configu- 
ration of  the  chest,  that  our  inspirations  should  be  uni- 
formly deep  and  full ; but,  from  the  great  inequality  of 
atmospheric  pressure  resulting  from  the  constant  fluctu- 
ations of  the  weather,  the  depth  and  fulness  of  the  inspi- 
ration are  exposed  to  frequent  diminution;  and  that 
play  of  the  chest,  which  is  as  requisite  to  a healthy 
state  of  the  lungs  as  exercise  to  muscular  development, 
is  consequently  subject  to  repeated  checks.  Thus, 
owing  to  the  want  of  due  excitement,  or,  more  strictly 
speaking,  of  proper  exercise,  the  healthy  functions  of 
the  chest  become  deranged,  its  expansion  restricted,  its 
action  languid,  and  by  degrees  its  shape  alters  ; so  that, 
instead  of  the  bony  compages  of  the  chest  being  forced 
boldly  out  in  a somewhat  semicircular  form,  and  the 
sternum  pushed  forward,  the  ribs  fall  in,  drawing  the 
breast-bone  backward  to  a position  nearer  the  spinal 
column  than  is  the  case  in  its  natural  movement.  Now, 
to  bear  out  and  verify  the  foregoing  remarks,  by  show- 
ing how^  requisite  the  expansible  power  of  the  chest  is 
to  the  healthy  constitution  of  the  lungs,  I would  state, 
as  an  almost  invariable  law,  that  the  commencement  of 
pulmonary  consumption  will  be  found  to  take  place  in 
the  superior  lobes  of  the  lungs,  owing  doubtless  to  the 
small  extension  of  the  upper  ribs  as  compared  with  the 
more  complete  movement  of  the  lower.  Another  sin- 
gular instance,  confirmatory  of  the  novel  view  I am  now 
taking  of  the  subject,  is  to  be  found  in  the  exemption 
of  asthmatic  patients  from  consumptive  disorder.  From 
the  peculiar  nature  of  their  complaint,  gasping  for 
breath,  and  forced  to  respire  frequently,  their  lungs  are 
ever  fully  exercised ; and  the  expansion  of  the  chest, 
which  follows  as  a necessary  consequence,  preserves 
the  sufferer  free  from  the  attacks  of  this  still  more  dread- 
ful malady.  To  come  to  the  third  head — depression  of 


40  OBSERVATIONS  ON  CONSUMPTION. 

spirits,  or  mental  anxiety — we  shall  meet  with  the 
same  cause  still  producing  the  same  elfects.  The  un- 
fortunate, who  lives  in  the  world  as  if  he  were  not  of  it, 
and  to  whom,  whether  his  cares  be  the  offspring  of  dis- 
appointed ambition,  hopeless  love,  or  ruined  circum- 
stances, the  world  displays  nothing  but  a cheerless 
blank — the  tenant  of  the  sick  chamber,  whose  distem- 
per improper  medical  treatment  has  unduly  prolonged, 
or  confirmed  ; in  hne,  all  who,  from  any  cause,  labour 
under  prostration  of  strength  or  general  debility,  are 
prone  to  fall  victims  to  the  insatiable  tyrant,  consump- 
tion, for  reasons  precisely  similar — inability  to  take  in- 
spirations of  depth  sufficient  to  keep  up  the  necessary 
changes  produced  by  the  air  on  the  venous  circulation. 
I have  adverted  to  another  cause,  which  in  my  opinion 
contributes,  at  least  in  a degree,  to  render  the  inhabit- 
ants of  this  country  more  peculiarly  liable  to  phthisis — 
a malformation  of  the  chest,  which,  after  repeated  and 
numerous  examinations  that  I have  been  enabled  to 
make  in  considerable  manufactories,  where  I had  the 
opportunity  of  comparing  foreigners  of  different  countries 
with  our  own  countrymen,  would  seem  to  be  more  preva- 
lent in  England  than  elsewhere.  As  a corrollary  to  the 
above  remark,  I may  note,  that  the  children  of  consump- 
tive parents  generally  inherit  the  narrowness  of  chest 
and  depression  of  the  ribs  which  characterize  the  vic- 
tims of  this  malady  ; and  that  thus  the  range  of  its  in- 
fluence is  indefinitely  increased. 

Following  up  the  tenour  of  the  preceding  observations, 
we  shall  find  that  the  benefit  usually  derived  from  a 
sea  voyage,  or  change  of  air,  is  not  so  much  due  to  the 
removal  from  an  impure  to  a purer  atmosphere,  per  se, 
as  to  the  stimulating  effects  produced  on  the  respiratory 
organs,  and  the  increased  energy  of  the  muscular  pow- 
ers of  the  chest,  on  which  pulmonary  dilatation  is  of 
course  consequent.  Let  us  compare  the  muscular  frame, 
expanded  chest,  and  robust  health  of  the  mariner,  or  of 
the  husbandman,  with  the  emaciated  figure,  contracted 
chest,  and  general  want  of  vigour  betrayed  by  the  arti- 
zan  of  manufacturing  cities  ; and,  on  attentive  consider- 
ation, we  shall  own  that  these  differences  are  the  con- 
sequences of  the  superior  expansion  and  activity  of  the 
pulmonary  apparatus  enjoyed  by  the  former. 


OBSERVATIONS  ON  CONSUMPTION.  41 

I must  now  advert  to  a very  remarkable  circumstance, 
upon  the  propriety  of  advancing  which  I have  long 
hesitated ; yet  as  it  serves  not  merely  to  elucidate  and 
strengthen,  but  to  prove  the  truth  of  the  propositions 
advanced  above,  and  is  a phenomenon  as  fatal  in  its 
elfects  as  it  is  singular  in  a physiological  point  of  view, 
I should,  after  mature  reflection,  deem  myself  the  slave 
of  a false  and  injurious  shame  were  I to  withhold  it. 
When  we  are  the  prey  of  other  disorders,  the  desires 
are  deadened,  and  lie  comparatively  dormant ; but  even 
in  the  last  stage  of  consumption  the  love  of  the  sex 
seems  to  increase  with  the  decay  of  the  strength,  and 
the  disease,  while  it  kills,  is  still  propagated  in  the  future 
life  of  an  unborn  being.  The  same  holds  true,  though 
in  a less  degree,  with  respect  to  the  gentler  part  of  the 
creation. 

Among  the  many  distressing  cases  which  the  medical 
practitioner  has  to  encounter,  the  premature  and  rapid 
decline  of  the  young  of  both  sexes,  more  particularly  of 
the  weaker,  is  without  doubt  the  most  painful.  The 
fragility  of  woman's  constitution,  as  compared  with  that 
of  man,  the  delicacy  of  her  frame,  her  retired  and  do- 
mestic habits,  and  the  sensitiveness  of  her  mind,  all 
contribute  to  render  her  a mark  at  which  consumption 
too  frequently  aims  his  deadly  darts.  No  sight  is  more 
painfully  interesting  than  that  of  a female,  on  the  veiy 
verge  of  womanhood,  yielding  unconsciously  to  the  fatal 
decree,  and,  like  a drooping  flower,  nipped  untimely  in 
the  bud,  graceful  and  lovely  to  the  latest  breath.  Inde- 
pendently of  her  greater  liability  to  pulmonary  disease 
from  delicacy  of  constitution,  there  exist  other  causes 
which  increase  her  susceptibility  in  a fearful  manner. 
The  style  of  her  dress— which,  in  compliance  with  the 
fantastic  usages  of  fashion,  seems  devised  to  alter  the 
free  and  graceful  outlines  traced  by  the  hand  of  nature 
into  a wasp-like  angularity,  alike  injurious  to  the  tender 
structure  of  her  body  and  unpleasing  to  the  eye  of 
taste — has  been  often  pointed  out  as  a pregnant  source 
of  disease,  and  justly  so.  It  has  been  already  observed, 
that  a full  and  free  dilatation  of  the  chest  is  absolutely 
necessary  to  preserve  the  lungs  in  a sound  and  healthy 
state  ; but  how  can  a femalp,  her  cheat  compressed  by 
an  artificial  support,  the  convexity  of  the  ribs  incapable 

6 


42 


CAUSES  OF  CONSUMPTION. 


of  being  extended  upward  and  outward,  and  the  stern- 
um consequently  without  the  power  of  coming  sufficient- 
ly forward,  enjoy  this  requisite  expansion?  She  is 
“ cribbed,  confined,”  and  “ curtailed  of  nature’s  fair  pro- 
portion” However,  to  counterbalance  these  incon- 
veniences, it  has  fortunately  happened,  that  owing  to  a 
power  she  possesses  of  abdominal  respiration,  more  de- 
cided in  her  than  in  the  male,  the  unnatural  restraint 
she  has  imposed  upon  herself  is  divested  of  some  portion 
of  its  ill  effects.  Still,  so  mischievous  are  the  conse- 
quences entailed  upon  woman  by  her  adherence  to  this 
baneful  part  of  her  costume,  that  in  consumptive  cases 
there  is  this  striking  distinction  between  the  sexes,  that 
the  female  thus  deprives  herself  of  the  great,  indeed  the 
sole  chance  of  recovery, — a due  expansion  of  the  chest. 
Thus  the  probability  of  spontaneous  and  permanent  re- 
covery, which  is  attended  by  an  increase  in  the  volume 
of  the  lungs,  is  sensibly  lessened  to  the  female  sufferer ; 
and  they  who  need  most  aid  maybe  said  “ to  take  arms 
against  themselves.” 


CAUSES  OF  CONSUMPTION. 

A COLD,  resulting  either  from  imprudent  exposure  to 
the  air  when  the  body  has  become  heated,  or  from  the 
wearing  of  too  light  and  insufficient  clothing,  is  deemed 
one  of  the  most  general  and  powerful  causes  of  con- 
sumption. Yet,  in  many  instances,  I am  persuaded  that 
the  real  and  efficient  cause  is  to  be  found  in  the  pre- 
existence of  latent  tubercles  in  the  lungs  ; and  when 
these  become  softened  by  general  indisposition,  pro- 
duced by  the  action  of  the  cold,  phthisis  ensues.  Fre- 
quently, indeed,  the  irritation  occasioned  by  latent  tu- 
berculous disease  will  determine  a catarrh,  and  the 
patient  will  be  treated  for  this  complaint  without  any 
suspicion  on  the  part  of  the  medical  attendant  of  the 
real  state  of  the  case.  Should  the  catarrh  continue, 
the  consumptive  disease  masked  by  it  will  be  effect- 
ually cured  : and  if  a cavity  has  been  formed,  this  will 
be  obliterated  by  the  increase  that  takes  place  in  the 
volume  of  the  lungs.  At  other  times  tuberculous  de- 


CAUSES  OF  CONSUMPTION. 


43 


posites  will  be  found  insulated,  and  rendered  innoxious, 
as  I shall  hereafter  explain,  by  the  secretion  of  black 
pulmonary  matter.  I have  verified  these  facts  by  nu- 
merous autopsies,  and  it  is  very  recently,  that,  open- 
ing the  body  of  an  asthmatic  individual  who  died  at 
the  advanced  age  of  seventy,  I found  distinct  traces  of 
a former  consumptive  state,  which,  having  been  arrested 
by  the  supervention  of  asthma,  had  existed  unknown 
to  himself,  his  family,  or  his  physician.  Still,  where  a 
hereditary  tendency  to  consumption  exists^  or  the  con- 
stitution has  been  previously  debilitated,  taking  cold  is 
most  certainly  a frequent  exciting  cause  of  pulmonary 
phthisis.  The  transmission  of  this  disease  from  parent 
to  child  is  a melancholy  fact  to  which  I have  already 
adverted.  The  generic  marks  of  this  sad  heir-loom  may 
be  traced  in  the  sanguine  yet  delicate  hue  of  the  coun- 
tenance, the  unusual  brightness  of  the  eyes,  the  con- 
fined and  narrowed  waist, ^ the  sharp  projection  of  the 
scapulse  or  shoulder-blades,  and  the  fragility  of  the  bony 
structure  of  the  body,  not  unfrequently  united  with  a 
disposition  to  an  unhealthy  stoutness.  In  laying  down 
' the  causes  of  consumption,  it  becomes  requisite  to  dis- 
tinguish between  those  which  are  direct,  and  the  far 
greater  class  commonly  confounded  with  them,  but 
which  in  point  of  fact  are  indirect.  Among  the  latter 
may  be  enumerated  inflammation  of  the  lungs,  pleurisy, 
contagious  eruptive  fever,  repelled  eruptions,  badness  and 
deficiency  of  food,  amenorrhoea,  unhealthy  localities, 
affections  of  the  abdominal  viscera,  (sometimes  caused 
by  excessive  drinking,)  spitting  of  blood,  constitutional 
syphilis,  and  a long  list  of  disorders,  whose  sole  in- 
fluence in  producing  consumption  consists  in  the  de- 
bilitated state  of  the  body  they  induce.  I have  said 
that  it  is  requisite  to  distinguish  between  the  direct 
and  indirect  causes  of  consumption,  not  that  there 
are  any  that  can  with  propriety  be  termed  direct,  but 
in  order  to  impress  thoroughly  upon  the  mind  the 
grand  truth,  that  phthisis  is,  for  the  most  part,  the  se- 
quence of  debilitated  bodily  health  alone.  When  the 
general  health  becomes  impaired,  a total  change  takes 
place  in  the  fluids  and  secretions  of  the  body,  and  there 
is  consequently  an  aberration  of  nutriment:  on  this, 
the  formation  of  tubercles  soon  follows. 


44 


CAUSES  OF  CONSUMPTION. 


Laennec  gives  an  interesting  account  of  the  effect  of 
depressing  passions  in  producing  phthisis,  in  the  case  of 
a religious  association  of  females,  all  of  whom  became 
consumptive  from  the  ascetic  spirit  which  regulated  their 
minds,  rather  than  the  austerity  of  their  diet.  Confine- 
ment, most  likely,  contributed  to  this  result.  Since  this 
society  was  bound  by  no  vow,  Laennec  persuaded  the 
members,  as  soon  as  consumption  was  clearly  indicated 
in  each,  to  change  to  another  place  of  abode,  and  he  ex- 
pressly declares  that  nearly  all  who  took  his  advice  re- 
covered. The  possibility  of  consumption’s  being  cured 
is  even  yet  denied  by  many  practitioners,  although  the 
light  of  truth  is  beginning  to  dawn  upon  them  ; and  yet 
the  above  relation  is  a proof,  that,  some  years  previously 
to  the  appearance  of  the  present  work,  the  greatest  med- 
ical authority  on  the  disease  had  stated  opinions  similar 
to  mine.  A parallel  circumstance  has  occurred,  in  the 
course  of  my  practice,  within  the  last  two  years.  Two 
young  ladies  were  removed  from  a school  in  the  neigh- 
bourhood of  London,  in  order  to  be  put  under  my  care 
for  consumption.  I ascertained  that  ten  or  twelve  of 
their  school-fellows  had  sunk  under  decline  within  the 
preceding  twelvemonth : and,  on  inquiry,  I found  that 
the  only  exercise  they  were  allowed,  and  this  but  sel- 
dom, was  the  prim,  formal  walk,  two  by  two ; which 
pernicious  and  false  decorum,  it  is  to  be  hoped,  will  soon 
be  banished  from  these  establishments. 

To  such  an  excess  were  the  fantastical  restrictions  of 
the  school  carried,  that  the  poor  girls  were  not  allowed 
to  hold  their  heads  erect,  or  maintain  a proper  carriage, 
being  told  that  so  to  do  was  a sign  of  pride.  By  this 
enforced  humility,  conjoined  with  the  radical  error — 
want  of  exercise — both  my  young  patients  not  only 
stooped,  but,  I am  sorry  to  add,  had  contracted  chests, 
and  lateral  curvature  of  the  spine. 

I should  mention  the  sequel  of  Laennec’s  account, 
in  order  to  establish  more  fully  the  coincidence  between 
the  circumstances,  and  to  direct  attention  to  the  ill  effects 
of  such  absurd  confinement.  He  proceeds  to  narrate, 
that  he  witnessed,  in  the  course  of  ten  years,  two  or 
three  renewals  of  the  religious  society,  by  the  admission 
of  new  members  to  replace  the  loss  of  old  ones ; and 
that  the  only  individuals  attached  to  it,  who  withstood 


CAUSES  OF  CONSUMPTION. 


45 


its  depressing  influence,  were  the  superior,  the  grate- 
keeper,  and  the  sisters  who  had  charge  of  the  kitchen, 
the  garden,  and  the  infirmary.  In  addition  to  the  exer- 
cise given  by  these  offices,  the  same  individuals  were 
called  upon,  occasionally,  to  visit  the  city  on  the  concerns 
of  the  establishment.  This  narrative  requires  no  comment. 

Many  writers  are  of  opinion  that  various  thoracic  dis- 
eases are  fruitful  causes  of  consumption ; but  I am  sat- 
isfied that  this  supposition  is  groundless.  It  is  merely 
owing  to  the  loss  of  health  entailed  by  them  that  the 
development  of  those  accidental  productions,  called 
tubercles,  takes  place.  To  enumerate  the  indirect  causes 
of  consumption  would  be  endless  ; for,  in  fact,  whatever 
is  capable  of  impairing  the  constitution  is  liable  to 
produce  a phthisical  state.  Thus  mental  anxiety,  or 
any  depressing  passion  long  continued,  as  well  as  chronic 
diseases  of  various  kinds,  engender  a consumptive  pre- 
disposition. In  this  country  the  frequency  and  preva- 
lence of  this  disease  are  attributed,  in  no  small  degree, 
to  the  great  and  sudden  vicissitudes  of  atmospheric 
temperature,  and  the  moist  nature  of  our  climate.  These, 
as  I have  already  explained,  operate  powerfully  in  ef- 
fecting changes  in  the  human  body,  more  or  less  calcu- 
lated to  affect  the  general  health  ; especially  in  those 
who  are  naturally  of  a delicate  make,  and  who  inherit 
a tendency  to  scrofula.  Particular  employments,  in  which 
dusty  particles  and  noxious  fumes  are  inhaled,  have  long 
been  regarded  as  producing  this  disease ; but  experience 
has  taught  me  that  some  catarrhal  affection,  and  not 
consumption,  is  what  most  frequently  supervenes,  and 
that  the  former  complaint  is  a preservative  against  the 
latter. 

The  distinguished  French  writer  I have  lately  quoted 
denies  that  j^thisis  'pulmonalis  is  a frequent  consequence 
of  pulmonary  catarrh  ; which  opinion  approximates  to, 
although  it  does  not  go  so  far  as  my  own ; but  it  is 
strange  that  so  acute  an  observer,  with  all  the  facts  be- 
fore him — facts  first  promulgated  by  himself — should 
have  stopped  short  of  the  truth  just  as  he  was  on  the 
point  of  reaching  it.  He  clearly  saw  that  catarrh  was 
not  the  cause  of  consumption,  and  affirms,  “We  recog- 
nise a thousand  instances  of  catarrh  for  one  of  phthisis.” 


46 


CAUSES  OF  CONSUMPTION. 


One  step  further  would  have  led  him  to  the  discovery, 
that  catarrh  was  the  remedy  of  nature  for  the  cure  of 
phthisis.  In  the  same  paragraph  he  alludes  to  Brous- 
sais,  as  supporting  the  once  established,  but  I trust  now 
exploded,  doctrine  of  ‘'phthisis  pulmonalis  being  the 
consequence  of  pulmonary  catarrh.”  Broussais,  indeed, 
had  the  temerity,  or  rather  folly,  to  assert,  that  a pupil 
of  his  used  to  bring  on  consumption — in  fact,  generate 
tubercles  in  the  lungs  of  a dog — by  irritating  the  trachea 
in  some  extraordinary  manner,  and  thus  producing  ca- 
tarrh. The  contrary  would  happen.  The  catarrh  would 
prevent  the  appearance  of  consumption.  But  what  will 
not  writers  advance  to  support  a favourite  theory ! 

Contagion  has  been  considered  in  the  southern  parts 
of  Europe,  especially  in  the  Italian  states,  as  a frequent 
source  by  which  large  families  of  children  have  been 
destroyed  by  consumption.  For  my  own  part,  it  has 
never  appeared  to  me  to  spread  among  individuals  hav- 
ing the  same  hereditary  constitution,  by  any  infectious 
medium ; but  by  other  circumstances  operating  upon  an 
inherent  predisposition  to  tuberculous  disease,  which,  as 
I have  already  said,  is  indicated  by  a particular  conform- 
ation of  the  body  ; such  as  a long  neck,  slender 
trunk  and  extremities,  contracted  chest,  high  shoulders, 
delicate  and  transparent  complexion,  weak  voice,  and 
great  sensibility.  The  same  locality  and  the  same  man- 
ner of  living,  no  doubt,  have  often  an  influence  in  pro- 
pagating it  in  certain  families  : and  to  this  cause,  and  not 
to  contagion,  we  may  attribute  its  remarkable  fatality. 
In  my  neighbourhood  there  are  many  Italian  residents, 
who,  for  the  most  part,  live  huddled  together  in  small 
and  ill-ventilated  rooms,  and  are  apparently  liable,  from 
their  peculiar  and  not  very  nutritive  diet,  a neglect  of 
cleanliness,  and  misery  and  disappointment  in  every 
shape,  to  have  a consumptive  constitution,  yet  I have 
not  been  able  to  trace  any  case  of  the  disease’s  being 
disseminated.  Still,  notwithstanding  my  firm  belief  that 
consumption  is  not  contagious,  I would  not  be  under- 
stood to  recommend  neglect  in  separating  consumptive 
from  healthy  persons ; on  the  contrary,  for  the  sake  of 
the  personal  comfort  of  the  sufferer,  and  to  forward  the 
chances  of  his  recovery,  I would  have  every  precaution 
taken  that  prudence  can  suggest,  or  kindness  inspire. . 


THE  SYMPTOMS  OF 


PULMONARY  CONSUMPTION, 

LOCAL  AND  SYMPATHETIC. 

j 


PHYSICAL  SIGNS  OF  THE  DISEASE. 

It  has  long  been  acknowledged  that  the  symptoms 
on  which  practitioners  generally  rely  in  the  incipient 
stage  as  indicative  of  consumption  are  extremely  va- 
riable and  uncertain.  Its  attack  indeed  is,  in  many 
instances,  so  deceitful  that  before  the  patient  is  in  the 
least  aware  of  his  danger  the  case  has  become  despe- 
rate. Again,  it  seldom  happens  that  pain,  or  any  other 
uneasy  sensation,  is  felt  in  the  part  which  is  well  known 
to  be  the  primary  seat  of  the  disorder,  although  it  re- 
sults from  tubercles,  disseminated  at  first  in  the  sub- 
stance of  the  upper  part  of  one,  or  both  lungs.  At 
other  times  we  see  cases  in  which  its  progress  is  latent 
and  altogether  unheeded ; still  a slight  cough  is  gene- 
rally the  first  symptom,  and  this  is  attributed  to  some 
uneasiness  in  the  throat,  produced  by  a common  cold. 
After  a time  the  cough  increases,  and  from  being  either 
hard  or  dry,  is  followed  by  the  expectoration  of  a little 
mucus,  often  devoid  of  colour,  as  in  common  catarrh. 
This  is  succeeded  by  some  degree  of  weight  and  slight 
pain  felt  in  the  chest,  along  with  difficulty  of  breath- 
ing, general  weakness,  and  an  accelerated  pulse,  which 
seldom  ranges  below  90  ; during  the  hot  stage  of  the 
hectic  fever  it  is  generally  120.  A sense  of  chilliness 
along  the  course  of  the  spine,  commonly  experienced 
toward  noon,  is  the  next  symptom ; this  is  followed  by 
an  augmented  temperature  of  the  body  on  the  approach 
of  evening,  and  finally  by  perspirations,  which  usually 
come  on  profusely  after  midnight,  and  greatly  attenuate 
the  body.  When  spitting  of  blood  occurs  with  the  fore- 
going symptoms,  or  when  the  matter  expectorated  be- 
gins to  assume  the  appearance  of  pus,  we  have  strong 
grounds  to  suspect  the  presence  of  pulmonary  consump- 


48  SYMPTOMS  OF  PULMONARY  CONSUMPTION. 

tion.  The  occurrence  of  cough  in  any  case,  in  which 
the  general  health  has  been  impaired,  ought  to  be  re- 
garded with  no  small  suspicion.  Cases  are  not  wanting 
in  which  the  disease  manifests  itself  most  irregularly. 
F or  instance,  the  usual  characteristic  symptoms  are  not 
uncommonly  preceded,  for  a short  time,  either  by  mesen- 
teric enlargement,  aphthae,  severe  diarrhoea,  amenorrhoea, 
or  by  an  affection  of  the  larynx,  attended  with  a slight  al- 
teration of  the  voice.  Though  in  the  early  stages  there  may 
be  some  doubt  as  to  the  existence  of  phthisis,  without  the 
aid  of  physical  signs,  there  can  be  however  little  chance 
of  mistake  in  the  advanced  stages.  As  soon  as  hectic 
fever  is  fully  established,  the  wasting  of  the  flesh  be- 
comes remarkable,  and  rapidly  increases,  if  perspiration^ 
diarrhoea,  and  expectoration  have  been  abundant.  To 
me,  who  have  been  for  so  many  years  accustomed  to 
see  this  disease  daily,  the  very  look  of  the  patient  is  in 
most  instances  sufficient. 

The  nose  and  cheeks  assume  a striking  prominency, 
and  the  bluish  paleness  and  emaciated  appearance  of 
the  face  are  remarkable,  when  contrasted  with  the 
suffused,  and,  at  other  times,  circumscribed  flush,  which 
quickly  goes  and  comes,  together  with  a shining  white  or 
pearl-blue  appearance  of  the  conjunctiva  of  the  eyes ; 
the  shoulder-blades  project,  so  as  to  be  likened  to  wings, 
while,  at  the  same  time,  the  chest  is  narrowed  in  its 
lateral  as  well  as  transverse  diameter,  in  consequence 
of  the  increased  convexity  of  the  ribs,  which  has  a great- 
er inclination  downward,  and  which  thus  likewise  admits 
of  the  nearer  approach  of  the  sternum  toward  the  back. 
On  the  upper  and  anterior  part  of  the  chest,  the  inter- 
costal spaces  appear  widened  and  depressed,  and  the 
belly  is  at  the  same  time  flat  and  retracted  ; — the  fingers 
seem  lengthened,  and  the  joints  of  these,  as  of  other 
parts,  are  apparently  enlarged ; incurvation  of  the  nails 
takes  place,  and  where  large  tuberculous  excavations 
have  long  existed,  an  actual  enlargement  of  the  ends 
of  the  fingers  is  observable ; the  neck  seems  elongated 
and  impeded  in  its  movements,  and  the  angles  of  the 
lips  are  drawn  back,  and  produce  a bitter  smile. 

Phthisis  is  not  difficult  to  be  recognised  in  that  stage 
in  which  the  tuberculous  mass,  becoming  softened,  finds 
an  opening  into  some  of  the  neighbouring  bronchia,  and 


SYMPTOMS  OF  PULMONARY  CONSUMPTION.  49 

finally  leaves  a cavity,  whose  existence  is  clearly  indi- 
cated by  its  characteristic  symptom — pectoriloquy. 
This  peculiar  phenomenon  is  generally  first  heard  in  the 
upper  portion  of  the  right  lung,  when  the  tubercles  which 
first  appear  there  are  softened  down  ; and  it  may  be 
detected  by  applying  the  ear  over  the  uppermost  ribs, 
or  over  the  infra-spinal  fossa  of  the  shoulder-blade. 
When  the  voice  of  the  patient,  on  applying  the  ear,  either 
alone  or  armed  with  the  stethoscope,  to  that  part  of  the 
chest  corresponding  with  the  supposed  seat  of  an  exca- 
vation, is  heard  much  louder  than  natural,  and  seems  to 
issue  uninterruptedly  from  within,  with  a thrilling  sound, 
it  constitutes  what  is  termed  a satisfactory  pectoriloquy, 
and  is  an  indubitable  sign  of  a tuberculous  cavity ; the 
contents  of  which  we  even  hear  not  unfrequently  by  the 
same  method  of  diagnosis,  agitated  by  the  action  of 
coughing.  Whenever  the  walls  of  an  old,  and  nearly 
emptied  excavation,  are  dense  and  firm,  a severe  fit  of 
coughing  gives  to  the  ear  a metallic  resonance,  or  a 
sound  as  of  some  empty  glasses  slightly  shaken  against 
each  other.  If  the  excavations  are  numerous,  and  com- 
municate one  with  another,  the  liquid  matter  within  is 
heard  changing  its  situation  every  time  the  patient 
breathes. 

The  plan  I always  pursue,  and  indeed  a most  ready 
one,  to  distinguish  consumption  from  pulmonary  catarrh, 
with  which  it  is  liable  to  be  confounded,  is  to  apply  the 
ear  to  the  posterior  part  of  the  chest,  about  two  or  three 
inches  below  the  inferior  angle  of  the  scapula.  Should 
the  respiration  be  almost  natural,  or  slightly  puerile 
here,  we  may  at  once  and  early  proclaim  the  case  to  be 
phthisical,  if  the  patient  have  a troublesome  cough, 
though  he  may  present  few  of  the  other  common  symp- 
toms belonging  to  a consumption.  Except  near  the  fatal 
termination  of  the  disease,  when  the  great  emaciation, 
confirmed  hectic  fever,  diarrhoea,  and  other  bad  symp- 
toms manifest  themselves,  we  have  no  physical  sign  of 
any  bronchial  inflammation ; save  in  cases  in  which 
some  progress  toward  recovery  has  taken  place.  When 
the  sonorous  rattle  occurs  before  the  lower  lobes  of  the 
lungs  are  affected  with  tubercles,  it  is  to  be  considered 
as  a highly  favourable  symptom.  In  other  cases,  how- 
ever violent  and  long  the  cough  may  be,  auscultation 

7 


50  SYMPTOMS  OF  PULMONARY  CONSUMPTION. 

gives  US  no  signs  of  the  catarrhal  state  which  precedes 
and  follows  complete  recovery.  Having  daily  opportu- 
nities of  seeing  new  consumptive  cases,  I readily  come 
to  a conclusion,  by  the  absence  of  catarrh,  that  they  are 
undoubtedly  consumptive,  without  taking  the  trouble  to 
ascertain  the  state  of  the  upper  part  of  the  chest ; for  if 
an  individual  coughs  up  blood,  or  rnuco-purulent  matter, 
is  subject  to  chills,  accessions  of  fever,  and  night  sweats, 
wastes  away  and  complains  of  debility,  and  no  catarrh 
is  heard  in  the  inspirations,  we  may  be  perfectly  satis- 
fied that  tuberculous  cavities  exist.  When  there  is  a 
cough  which  is  not  influenced  by  remedies,  and  the 
sympathetic  signs  of  consumption  and  the  auscultatic 
results  beneath  the  clavicles  are  somewhat  unsatisfac- 
tory, while  the  lower  part  of  the  chest  has  the  murmur 
of  respiration  almost  natural,  I should  then,  satisfied 
with  the  experience  derived  from  exploring  the  chests 
of  several  thousand  consumptive  patients,  unhesitatingly 
pronounce  the  case  to  be  genuine  consumption.  In  nu- 
merous instances,  much  to  the  surprise  of  my  pupils, 
and  of  those  practitioners  who  have  witnessed  my  prac- 
tice, I have  pronounced  a patient  to  have  tuberculous 
disease  in  the  superiour  lobes,  while  he  exhibited  no 
look  indicative  of  such  serious  illness,  but  had  merely 
an  annoying  cough.  This  prompt  decision  after  I have 
ascertained  by  the  ear  the  sanity  of  the  respiratory  mur- 
mur, and  absence  of  bronchial  irritation  in  the  inferior 
part  of  the  chest,  has  generally  proved  correct.  In  some 
instances,  obscure  respiration  in  the  upper  part  of  the 
chest,  arising  from  tubercles  and  pulmonary  induration  ; 
in  others,  a tuberculous  cavity,  affording  the  most  per- 
fect pectoriloquism,  has  been  ascertained;  and,  on 
closely  questioning  the  patient,  the  symptoms  he  has 
detailed  have  usually  been  corroborative  of  what  might 
be  termed,  if  we  were  guided  by  the  apparently  unim- 
paired state  of  health,  latent  phthisis. 

It  were  easy  to  enter  into  a more  full  and  minute  de- 
tail of  the  symptoms  which  characterize  this  complaint ; 
but  as  my  present  object  is  to  elucidate  the  preventive 
and  sanatory  treatment  to  be  observed,  I deem  it  advis- 
able to  reserve  many  observations  of  a curious  nature 
connected  with  this  branch  of  my  subject.  However, 
should  I have  occasion  to  reprint  this  work,  I may  be 


MORBID  APPEARANCES  OF  CONSUMPTION.  51 

tempted  to  enlarge  the  present  chapter,  and  publish  many 
interesting,  and,  as  far  as  my  knowledge  extends,  ori- 
ginal facts. 

I suffer  this  passage  to  remain  as  it  stood  in  the  for- 
mer editions,  as  a renewed  pledge  to  fulfil  the  promise 
thus  given.  The  call  made  upon  me  for  a new  im- 
pression, as  well  as  a pressure  of  literary  and  profes- 
sional labour,  prevents  me  from  redeeming  my  word  at 
present ; but  as  I am  now  engaged  in  an  extensive  work 
on  the  Diseases  of  the  Chest,”  I shall  have  an  oppor- 
tunity of  pursuing  the  inquiry  through  all  its  ramifica- 
tions. There  is  no  branch  of  my  subject  on  w^hich 
more  contradictory  opinions  have  been  emitted.  Facts 
themselves  have  been  so  differently  described  as  to  as- 
sume the  most  opposite  aspects.  The  founder  of  the 
science  of  auscultative  examination  was  induced  not  in- 
frequently into  error  by  over  anxiety  to  complete  his 
system ; and  too  many  of  his  followers  have  repeated 
his  oversights,  or  committed  fresh  mistakes  from  inac- 
curate observation,  and  want  of  a proper  field  for  its  ex- 
ercise. 


MORBID  APPEARANCES  OF  CONSUMPTION. 

The  most  common  morbid  appearances  met  with  in 
the  lungs  are  a peculiar  species  of  accidental  produc- 
tion, known  under  the  generic  name  of  tubercles.  These, 
according  to  the  different  appearances  they  present,  may 
be  distinguished  into  two  primary  forms — that  of  insu- 
lated bodies,  and  that  of  interstitial  infiltration  or  secretion. 
In  the  former  are  classed  miliary  tubercles,  so  named 
from  their  size,  which  usually  corresponds  with  that  of 
a millet  seed,  although  they  are  sometimes  found  much 
larger.  In  their  origin  they  are  observed  to  be  semi- 
transparent, and  of  a grayish  colour,  sometimes  nearly 
colourless  and  transparent.  On  superficial  inspection, 
they  are  apparently  orbicular,  but,  when  more  minutely 
observed,  occasional  angularities  and  infractuosities  are 
visible.  So  closely  are  they  interwoven  with  the  fibre 
of  the  lungs,  that  it  is  found  impossible  to  separate  them 
without  bringing  away,  at  the  same  time,  a part  of  the 
former.  They  gradually  approximate  to,  and  unite  with 


52  MORBID  APPEARANCES  OF  CONSUMPTION. 

each  other,  forming  semi-cartilaginous  groups  or  masses, 
which  in  time  acquire  a light  straw  colour,  and  change 
into  a substance  of  the  consistency  of  cheese.  When 
they  thus  spread  and  unite  by  intussusception,  they  form 
what  is  technically  denominated  crude  tubercles,  or  yel~ 
low  crude  tubercles.  Their  progress  to  this  state  com- 
mences with  the  appearance  of  yellow,  opaque  specks 
occurring  generally,  but  by  no  means  uniformly,  as  has 
been  erroneously  stated,  in  their  centres.  These  tuber- 
cles, increasing  by  degrees,  either  unite  in  the  manner 
described  above,  or  remain,  when  thus  converted  into 
the  crude  state,  separate  and  isolated.  A strong  proof 
of  the  soundness  of  the  principle  I am  anxious  to  in- 
culcate throughout  this  work,  namely,  that  pulmonary 
consumption  is  seldom  met  with  in  individuals  of  large 
and  expanded  chests,  will  be  found  in  the  fact  that  these 
nodules,  or  tubercles,  almost  invariably  commence  in 
the  upper  portion  of  the  lungs,  which,  by  the  very  struc- 
ture of  the  thorax,  is  their  most  confined  part.  From 
the  summit  they  spread  downward,  and  in  their  single 
formation  will  enlarge  to  the  size  of  a hazel  nut,  although 
rarely ; indeed,  I consider  it  probable,  that  when  they 
apparently  reach  these  dimensions  they  are  not  in  point 
of  fact  single,  but  an  aggregation,  so  compacted  as  to 
defy  separation. 

A second  form  of  insulated  bodies  are  the  gramdar 
tubercles,  first  pointed  out  by  Bayle,  who  regarded  them 
as  an  accidental  cartilaginous  formation,  different  from 
tubercles  ; but  without  sufficient  reason,  since,  on  divid- 
ing them,  we  find  that  they  present  the  same  colour  and 
opacity  as  the  common  tubercle,  and  their  growth  evi- 
dently proceeds  through  the  same  stages : therefore,  I 
am  of  opinion  that  they  are  unquestionably  the  same. 
The  principal  distinction  between  the  two  consists  in 
their  external  form.  The  granular  tubercles  are  round- 
ish or  ovoid,  of  the  size  of  a millet  seed,  which  they 
seldom  exceed,  and  germinate  singly  in  immense  num- 
bers over  an  entire  lung,  or  its  greater  portion,  so  that 
even  where  apparently  blended,  the  granules  are  found, 
on  examination,  to  be  entirely  distinct.  They  differ 
still  further,  by  their  being  transparent  and  colourless. 
Their  induration  and  cartilaginous  structure  may  arise, 
it  is  not  unreasonable  to  suppose,  from  their  remaining 


' MORBID  APPEARANCES  OF  CONSUMPTION.  53 

during  a long  period  without  showing  any  disposition  to 
suppurate,  which  they  are  sometimes  however  found 
to  do. 

I have  stated,  that  one  of  the  principal  differences  be- 
tween the  miliary  and  the  granular  tubercles  consists  in 
the  latter  being  colourless  and  transparent ; yet  this  is 
not  an  invariable  distinction,  since  they  occur  at  times 
of  a grayish  tint,  and  are  not  invariably  diaphanous, 
but  in  conjunction  with  this  gray  colour  are  also  semi- 
transparent, thus  furnishing  an  additional  proof  of  their 
assimilation  with  the  miliary  tubercle. 

The  second  form  in  which  tuberculous  matter  exhib- 
its itself  in  the  lungs  is  that  of  interstitial  infiltration ; 
this,  like  the  first,  may  be  divided  into  two  classes,  one 
of  which  may  be  denominated  gray  tuberculous  infiltra- 
tion, and  the  o\h.er  jelly-like  tuberculous  infiltration.  The 
former  is  found,  in  this  the  second  stage  of  the  tubercu- 
lar progress,  infiltrated  around  tubercular  cysts,  and  in- 
corporated, if  I may  use  the  term,  with  the  pulmonary 
tissue.  Occasionally  it  is  met  with  in  a separate  deposite, 
independent  of  the  previous  formation  of  miliary  tuber- 
cles, and  forms  large  masses  of  a moist  compact  sub- 
stance, impenetrable  by  the  air.  Its  grayish  hue  is  de- 
rived from  the  secretion  of  black  pulmonary  matter  in 
minute  particles.  Softening  gradually,  in  a manner 
similar  to  the  insulated  tubercle,  it  passes  into  a state  of 
crudity,  which  is  indicated  by  minute  yellow  and  opaque 
points,  or  specks.  On  making  a section  of  this  mass, 
the  matter  contained  in  these  minute  specks  oozes  out, 
and  there  remain  small  orifices  similar  to  so  many  holes 
left  by  the  mark  or  prick  of  a pin.  The  jelly-like  sub- 
stance, termed  the  jelly-like  tuberculous  infiltration,  is 
discovered  in  the  intervals  of  the  miliary  tubercles,  and 
is  for  the  most  part  colourless,  although  occasionally  it 
is  tinged  with  red.  Gradually  gaining  greater  consist- 
ency, (says  Laennec,)  it  becomes  converted  into  yellow 
tuberculous  matter ; and  this  indeed,  according  to  him, 
at  times  so  rapidly,  that,  on  inspecting  large  masses  of 
the  substance  thus  changed,  we  are  often  unable  to  find 
any  trace  of  its  original  state  : but,  according  to  my 
own  opinions,  which  have  been  based  on  observations 
continued  for  a series  of  years,  this  view  is  altogether 
erroneous,  since  the  jelly-like  infiltration  is,  I ^conceive. 


54  MORBID  APPEARANCES  OF  CONSUMPTION. 

the  result  of  specific  chronic  inflammation.  Nor  does 
this  jelly-like  infiltration,  or,  more  correctly  speaking, 
secretion,  ever  become,  as  far  as  I am  aware,  converted 
into  yellow  tuberculous  matter.  Again,  the  secretion, 
of  which  we  are  now  speaking,  is  precisely  similar  to 
that  morbid  deposite  frequently  found  beneath  the  serous 
surface  of  the  lungs,  in  cases  of  chronic  pleurisy ; and 
in  chronic  inflammation  of  the  heart  I have  repeatedly 
seen  the  same  gelatinous  matter,  beneath  the  serous 
investure  of  the  auricles  and  that  of  the  ventricles,  with- 
in the  laminse  of  the  pericardium,  and  underneath  the 
serous  surface  of  parts  within  the  abdominal  cavity. 
These  facts  are  strong  corroborations  of  my  opinion  as 
to  the  specific  chronic  nature  of  this  secretion  ; but 
when  we  find  the  presence  of  capillary  vessels,  extend- 
ing themselves  into  this  gelatinous  matter,  which  minute 
vessels  are  also  traced  in  the  jelly-like  secretion  of  the 
different  parts  above  mentioned,  I think  my  assertion 
fully  borne  out.  To  extend  my  proofs  still  further,  I 
may  observe,  that,  in  some  severe  chronic  diseases  of 
the  joints,  I have  seen  a like  secretion  on  the  exterior 
surface  of  the  sinovial  capsule,  extending  itself  to  no 
inconsiderable  distance  into  the  surrounding  cellular 
membrane. 

The  process  by  which  both  the  insulated  and  diffused 
tuberculous  matter  becomes  softened  into  a fluid  state 
is  similar.  Generally,  a number  of  small,  yellow,  opaque 
specks  make  their  appearance  in  the  centre  of  several 
coalesced  tubercles,  and  in  different  parts  of  the  dif- 
fused tuberculous  matter,  until,  by  degrees,  the  whole  of 
the  substance  is  converted  into  a uniform  yellow  mass, 
which  after  an  uncertain  period  becomes  softened,  and 
is  changed  into  thick  and  curdy  pus.  However,  the 
consistency  of  this  pus  is  by  no  means  invariably  the 
same,  a portion  assimilating  to  the  secretion  from  an 
ordinary  sore,  and  being  thin  and  watery.  In  expe- 
diting this  change  in  the  tuberculous  mass  from  hard 
to  soft,  the  secretion  from  the  lining  surface  of  the  mem- 
brane circumscribing  it,  I entertain  no  doubt,  contributes 
not  a little.  I find  in  a work  published  by  M.  Lombard 
of  Geneva  that  he  supposes  each  portion  of  tuberculous 
matter  to  act  like  a foreign  body  on  the  tissues  with 
which  it  is  in  contact,  thus  producing  a secretion  of  pus 


MORBID  APPEARANCES  OF  CONSUMPTION.  55 

mechanically  dividing*  the  tubercle  into  clots  ; but  I con- 
ceive that  this  gentleman,  though  partially  correct,  at- 
tributes too  much  to  the  action  of  this  fluid,  since  we 
find  a particle,  or  particles  of  pus,  contained  within  the 
solitary  tubercle,  and  evidently  not  in  contact  with  any 
tissue  having  the  power  of  generating  pus — nay,  more, 
we  find  deposites  of  pus  in  the  large  tuberculous  masses, 
in  which  the  natural  alveolar  structure  of  the  lungs  is  by 
no  means  discernible.  When  a secretion  of  pus  takes 
place,  and  (partly  established  by  a process  of  irritation) 
to  an  amount  sufficient  to  effect  a solution  of  continuity, 
an  opening  is  made  into  some  of  the  neighbouring  bron- 
chial tubes,  or  into  some  tubercular  cavity,  of  previous 
formation  communicating  with  them.  By  this  compound 
process,  according  to  the  foregoing  view,  the  elimina- 
tion of  tuberculous  granules  is  effected.  The  interior 
of  such  cavities,  when  of  large  extent,  has  columnar 
bands  extending  across  it ; these  are  formed  of  con- 
densed pulmonary  tissue,  and  they  are  sometimes  coat- 
ed with  the  tuberculous  degeneracy ; it  should  be  ob- 
served, that  none  of  the  bronchial  ramifications  traverse 
these  excavations,  and  that  the  few  vessels,  occasionally 
seen  within  the  bands,  are  in  almost  every  instance 
obliterated.  In  the  parietes  of  the  large  anfractuous 
excavations  of  long  standing,  the  blood-vessels  are  fre- 
quently observed  in  a flattened  state,  and  those  that  are 
obliterated  are  covered  by  a thin,  semi-cartilaginous 
membrane  : the  bronchial  ramifications,  on  the  contra- 
ry, with  the  exception  of  those  necessary  for  the  dis- 
charge of  sputa,  though  found  obliterated,  and  invaria- 
bly discovered  to  be  cut  off,  yet  would  appear  to  have 
been  originally  enveloped  by  the  tuberculous  matter, 
and  to  have  traversed  the  space  it  occupies.  As  soon 
as  these  cavities  have  discharged  their  contents,  they 
become  lined  by  a soft,  thin,  and  nearly  opaque  morbid 
membrane,  or  are  merely  invested  by  an  exudation, 
which  is  in  some  parts  deficient,  and  varies  in  density. 
At  times,  we  meet  with  cases  in  which  laminsB  of  a light 
blue  colour,  and  semi-cartilaginous  nature,  line  these 
excavations,  interspersed  here  and  there  with,  slight  emi- 
nences, and  in  intimate  connection  with  the  pulmonary 
tissue,  being  continuous  also  with  the  lining  membrane 
of  the  bronchia.  At  others,  the  boundaries  of  the  exca- 


56  MORBID  APPEARANCES  OF  CONSUMPTION. 

vations  are  found  without  either  of  the  false  membranes^ 
and  are  formed  by  the  natural  texture  of  the  lungs 
merely  condensed,  or  infiltrated  with  tubercular  matter^ 
In  concluding  my  remarks  on  the  formation  of  the  tu- 
berculous cavities,  I must  express  my  concurrence  with 
the  view  taken  by  M.  Bayle,  of  the  false  membrane’s 
secreting  the  pus  which  is  expectorated,  instead  of  its 
being  the  product  of  the  bronchial  secretion.  The 
grounds  on  which  I rest  my  opinion  are  these — in  the 
first  place,  that  no  bronchial  alfection  is  perceptible  until 
the  disease  is  drawing  to  a close,  or  unless  nature  at- 
tempts to  effect  a cure  by  the  supervention  of  catarrh ; 
and,  in  the  second  place,  that,  on  dissection,  we  do  not 
find  these  excavations  frequently  empty,  as  stated  by 
Laennec,  but  that  they  generally  contain  no  inconsider- 
able quantity  of  puriform  matter,  similar  to  the  sputa 
which  had  been  ejected  by  the  patient. 

The  stage  of  my  subject  at  which  I have  now  arrived 
leads  me  to  the  consideration  of  encysted  tubercles . Al- 
though seldom  met  with,  except  in  the  bronchial  glands, 
yet,  in  at  least  a dozen  instances,  I have  found  these 
tubercles  surrounded  previously  to  softening  by  an  ac- 
cidental membranous  formation,  and  sometimes  by  con- 
densed pulmonary  tissue.  Still,  seldom  as  this  occurs. 
Nature,  ever  prone  to  discover  and  apply  a remedy  to 
her  own  infirmities,  has  benignantly  provided  that  the 
black  deposite,  caused  by  the  tuberculous  irritation,  shall 
answer  every  purpose  of  a cyst.  It  has  often  happened 
to  me  to  have  had  opportunities  of  examining  patients 
of  my  own,  who,  after  having  recovered  from  consump- 
tion, and  enjoyed  a good  state  of  health  for  years,  have 
expired  of  diseases  not  referable  to  the  pulmonary  or- 
gans. In  many  of  these  instances,  in  which  ulcers  of 
the  lungs  have  been  transformed  into  semi-cartilaginous 
fistulee,  or  in  which  perfect  cellular  cicatrization  has 
taken  place,  I have  remarked,  that  such  nodules  of  tu- 
bercles as  then  existed  have  become  enveloped  by 
black  pulmonary  matter,  which  by  isolating  them,  and 
rendering  them  innoxious,  has  evidently  produced  the 
same  beneficial  effects  as  would  have  resulted  from  the 
encysted  state.  Indeed,  I have  reason  to  believe,  from 
inquiring  into  the  history  of  the  cases  of  many  persons, 
who  in  their  youth  bad  laboured  under  consumption, 


MORBID  APPEARANCES  OF  CONSUMPTION.  57 

from  which  they  afterward  recovered,  and  on  whose 
demise  I have  been  called  in  to  examine  the  body,  that 
latent  nodules,  in  the  state  described  above,  have  exist- 
ed upward  of  thirty  years.  Again,  in  individuals  in 
whom  consumption  has  been  arrested  by  the  spontane- 
ous occurrence  of  chronic  catarrh,  or  by  treatment 
adapted  to  render  the  disease  chronic,  similar  nodules 
similarly  situated,  together  with  wrinkled  depressions 
on  the  exterior  surface  of  the  lungs,  signs  of  internal 
cicatrices,  are  of  no  infrequent  occurrence.  Without 
intending  to  enter  too  far  into  the  debateablei  ground  of 
hypothesis,  I yet  feel  induced  to  observe  that  I regard 
tubercular  deposition  as  a specific  vitiated  secretion, 
arising  from  an  aberration  of  nutrition.  In  confirmation 
of  this  opinion,  I have  strong  grounds  for  believing  that 
tubercles  of  very  recent  date,  and  not  arrived  at  a state 
of  crudity,  undergo  absorption,  and  that  upon  this  re- 
storation from  incipient  phthisis  soon  follows.  Thus  I 
have  indicated  two  modes  by  which  recovery  from 
phthisis  occurs  ; the  one  is  the  reabsorption  of  tubercles 
in  their  early  state,  and  the  other  is  their  insulation,  even 
in  a state  of  crudity,  by  black  pulmonary  matter.  I 
now  approach  what  I consider  the  most  interesting  por- 
tion of  my  subject  connected  with  the  morbid  anatomy 
of  phthisis,  the  mode  of  union  and  cicatrization  of  ulcer- 
ous excavations,  which  seems  by  no  means  understood. 
Whenever  nature  operates  a cure,  there  is  an  extension 
of  irritation  from  the  lining  of  the  cavity  into  the  neigh- 
bouring bronchial  tubes ; and  the  consequence  of  this 
is,  supposing  there  exist  one  or  more  cavities,  in  the 
summit  of  the  right  lung  for  example,  (since  the  right  is 
the  one  generally  first  attacked,)  an  emphysematous 
state  of  the  vesicular  structure  of  that  portion  of  the 
lung,  through  imprisonment  of  the  air  in  the  act  of  ex- 
piration. Hence,  through  enlargement  of  the  aerial 
cells,  and  consequent  voluminous  state  of  the  pulmonary 
tissue,  the  pressure  is  so  constantly  exerted  from  with- 
out inward  on  the  exterior  of  the  cyst,  that  in  time  an 
apposition  of  the  parietes  of  the  cavities  takes  place, 
and  the  ulcerous  excavation  becomes  healed  by  the  first 
intention.  If  the  healing  occurs  early,  and  the  cavity 
is  not  of  old  date,  cellular  cicatrization  is  the  conse- 
quence ; but  if  no  pulmonary  catarrh  supervenes  until 


58  MORBID  APPEARANCES  OF  CONSUMPTION. 

after  phthisis  has  existed  for  a length  of  time,  the  cica- 
trizations are  commonly  formed  of  fibro-cartilaginons 
lamellee,  or  there  is  left  an  imperfect  cicatrix  with  semi- 
cartilaginous  fistula.  Whenever  vesicular  emphysema 
exists,  recent  tubercles  are  rarely  seen ; hence  it  hap- 
pens that  fresh  crops  of  tubercles  have  no  disposition  to 
appear  in  the  cicatrized  summit  of  the  newly  healed 
lung ; but  if,  after  recovery  has  taken  place  through 
this  change,  any  circumstance  should  arise  to  injure  the 
patient’s  health,  the  summit  of  the  other  lung,  not  being 
emphysematous,  may  be  the  seat  of  a fresh  formation 
of  tubercles ; and  the  fresh  successive  crops  of  tuber- 
cles may  even  appear  beneath  the  emphysematous  por- 
tion of  the  summit  of  the  right  lung,  as  well  as  in  other 
parts.  In  the  progress  of  the  disease,  when  unchecked, 
these  crops  proceed  downward  by  progressive  stages. 
No  sooner  has  a cavity  been  formed  in  the  summit  of 
either  lung,  than,  after  an  indefinite  period,  a succeed- 
ing eruption  appears  lower  down,  so  that  the  appear- 
ances, presented  on  dissection,  show  the  inroads  of  the 
disorder  from  its  direst  ravages  down  to  its  latest  attacks. 
Thus,  an  anfractuous  cavity  is  generally  found  in  the 
summit,  surrounded  by  tubercles  in  an  advanced  state 
of  crudity ; somewhat  lower  down  are  smaller  cavities 
containing  portions  of  undissolved  tuberculous  matter, 
and  around  them  small  nodules  assuming  the  yellow 
appearance ; beneath  these  the  crude  miliary  tubercles 
are  apparent,  having  their  centres  already  occupied  with 
yellow  points  ; and  lastly,  the  transparent  miliary  tuber- 
cles, which  form  the  first  morbid  tuberculous  appear- 
ance in  pulmonary  consumption,  occupy  the  inferior 
portion  of  the  lower  lobes  of  the  lungs.  I ought  here 
to  mention  that,  if,  after  tubercles  are  deposited,  or  a 
cavity  is  formed  in  the  summit  of  the  lung,  general  vesi- 
cular emphysema  arises  in  consequence  of  catarrhal  af- 
fection, or  of  irritation  spreading  through  the  ramifica- 
tions of  the  bronchi  from  the  seat  of  the  disease,  there 
will  be  no  disposition  to  the  formation  of  tubercles. 
This  strange  and  singular  exception  may  be  probably 
the  result  of  the  extraordinary  exercise  of  the  pulmo- 
nary apparatus,  caused  by  the  frequency  of  respiration 
inseparable  from  catarrh  or  asthma.  Most  truly  does 
Laennec  observe,  what  my  own  extended  experience 


MORBID  APPEARANCES  OF  CONSUMPTION.  59 

confirms,  that  tubercles  are  less  frequently  met  with  in 
the  muscles  of  voluntary  motion  than  elsewhere  ; and 
in  this  we  find  a strong  confirmation,  given  by  the  hand 
of  nature  herself,  of  the  value  of  artificial  means  to  in- 
crease the  action  of  the  lungs,  and  thus  arrest  any  new 
development  of  tuberculous  eruptions. 

Before  I conclude  my  observations  on  the  morbid  ap- 
pearances, I deem  it  necessary  to  notice  the  organic 
changes  which  accompany  phthisis,  many  of  which  are 
entirely  dependant  on  the  particular  treatment  to  which 
the  patient  may  be  subjected.  The  intestines,  more  es- 
pecially the  small,  are,  next  to  the  lungs,  the  most  liable 
to  tuberculous  degeneration,  leading  to  the  ulcerous  state, 
which  in  its  turn  keeps  up  profuse  and  wasting  purga- 
tion. This  troublesome  condition  may,  in  many  instan- 
ces, be  avoided  by  a plan  of  treatment  which  the  read- 
er will  find  laid  down  in  another  part  of  this  work. — 
More  than  one-fourth  in  a hundred  adult  subjects,  ac- 
cording to  Dr.  Lombard,  had  tubercles  in  the  intestines ; 
but  I have  found,  that,  under  judicious  management,  this 
proportion  may  be  considerably  decreased.  Being  de- 
sirous, however,  to  see  how  far  phthisical  patients  were 
liable  to  this  intestinal  affection,  I found  that,  out  of  the 
same  number  of  adult  subjects  who  came  under  my 
notice,  less  than  a sixth  part  had  intestinal  tubercles  : 

4 yet,  though  such  was  the  result  of  my  inquiry  with 
respect  to  these  particular  cases,  I cannot  but  allow  that 
the  relative  proportion,  as  stated  by  M.  Lombard,  is, 
generally  speaking,  correct.  Next,  in  order  of  frequency, 
as  subject  to  the  tuberculous  state,  are  the  mesenteric, 
bronchial,  and  the  cervical  ganglions ; the  viscus  most 
liable  to  be  affected  after  the  intestines  is  the  spleen ; 
then  the  kidneys,  and,  less  rarely,  the  liver.  A wide 
difference,  however,  in  the  proportions  above  estimated, 
and  in  the  liability  of  the  several  parts  to  tubercles,  ac- 
cording to  the  order  I have  just  set  down,  is  met  with 
in  young,  as  compared  with  adult  subjects.  Thus  intes- 
tinal tubercles  are  more  rare  in  the  former  than  in  the 
latter,  but  the  mesenteric,  as  well  as  the  bronchial  gan- 
glions, are  much  more  frequently  the  seat  of  this  disease 
in  children  than  adults : and  the  result  of  repeated  ex- 
aminations has  proved  to  me,  that  the  presence  of  tu- 
bercles is  oftener  detected  in  the  nervous  centres  of  chil- 


60  MORBID  APPEARANCES  OF  CONSUMPTION. 

dren  than  in  those  of  adults.  Were  I to  follow  the  bias 
of  my  inclination,  I should  willingly  extend  my  re- 
marks on  this  interesting  branch  of  my  subject  still 
further ; but  the  plan  of  the  present  work  precludes  me 
from  entering  upon  a more  detailed  notice.  I am  thus 
necessarily  restricted  to  brevity,  in  my  observations  on 
the  principal  lesions  which  accompany  phthisis  pulmo- 
nalis. 

It  is  with  no  small  degree  of  surprise,  that  I perceive 
it  stated  by  a French  physician  of  eminence,  M.  Louis, 
that  peripneumony  and  pleurisy  were  found  by  him  to 
occur  in  so  small  a proportion  as  one-tenth  of  the  cases  ; 
whereas  I am  fully  persuaded  that,  in  the  last  stage  of 
consumption,  not  less  than  one-fourth,  nor  should  I ex- 
aggerate by  stating  the  proportion  as  greater,  display, 
on  dissection,  one  or  both  of  these  diseases.  Another 
strange  error  into  which  a medical  writer  of  the  same 
country,  M.  Andral,  has  fallen,  is  his  supposition  that 
peripneumony  is  common  in  the  early  stages  of  the  dis- 
ease, the  contrary  being  decidedly  the  fact.  I admit 
that  partial  peripneumonies,  around  the  nodules  of  tuber- 
cles, are  not  uncommon  ; but  the  cases  are  rare  indeed 
in  which  the  disease  occupies  the  lower  lobes  of  the 
lungs,  the  usual  seats  of  inflammation.  Were  phthisi- 
cal patients  so  frequently  affected  with  pulmonary  in- 
flammation as  M.  Andral  describes,  the  duration  of  con- 
sumption would  be  wonderfully  shortened.  One  dis- 
eased state  or  other  of  the  mucous  membrane  of  the 
trachea,  of  the  larynx,  and  of  the  epiglottis,  occurs  in 
the  same  ratio  as  pneumonia ; but  these  affections  are 
of  infrequent  occurrence  until  phthisis  has  made  con- 
siderable progress.  Fortunate  indeed  would  it  be  for 
consumptive  patients  to  be  early  attacked  with  inflam- 
mation of  some  part  of  the  great  air  passage,  since,  in 
such  case,  the  progress  of  their  disease  would  be  effect- 
ually checked.  I would  here  particularly  draw  atten- 
tion to  an  important  circumstance,  which,  if  left  unex- 
plained, might  appear  subversive  of  the  very  principles 
and  practice  I would  inculcate  throughout  this  work.  It 
may  reasonably  be  inquired,  if  inflammation  of  the  air 
passage,  in  one  part  or  other,  oppose  so  completely  the 
progress  of  consumptive  disease,  how  does  it  happen, 
that  in  numberless  cases  we  find  the  first  symptoms  of 


MORBID  APPEARANCES  OF  CONSUMPTION.  61 

phthisis  exhibited  by  the  patient  to  consist  in  loss  of 
voice,  hoarseness,  and,  in  short,  all  the  apparent  evi- 
dences of  laryngeal  affection,  and  yet  the  pulmonary 
disorder  receive  no  visible  relief  ? Now  auscultative 
experience  has  clearly  demonstrated  to  me  that,  in  cases 
of  this  kind,  latent  tubercular  disease  invariably  exists 
in  the  lungs  previously  to  this  aphonia  ; and  that  this 
very  loss  of  voice,  and  accompanying  hoarseness,  are 
the  results  of  a thickening  and  ulceration  of  the  mucous 
membrane  of  the  ventricles,  and  vocal  chords  of  the 
larynx  alone,  which,  however,  do  not  present  an  obstruc- 
tion to  the  expiration  so  as  to  excite  the  action  of  the 
lungs,  in  the  decided  manner  effected  by  catarrhal,  or 
asthmatic  complaints.  There  exists,  indeed,  an  essential 
difference  in  the  character  and  effects  of  this  distressing 
aphonia,  and  of  catarrhal  disorder.  However,  notwith- 
standing all  the  various  symptoms  of  phthisis  proceed 
uninterruptedly,  in  patients  so  afflicted ; yet,  through  a 
subacute  irritation  in  the  ventricles  of  the  larynx,  at 
last  producing  a swelling  of  the  surrounding  mucous 
tissue,  so  as  to  encroach  sufficiently  on  the  area  of  the 
windpipe  to  cause  a slight  obstruction  to  the  expiratory 
process,  consumptive  subjects  of  this  class  live  at  least 
twice  as  long  as  the  generality  of  those  whose  disease 
is  not  accompanied  by  such  laryngeal  affection. 

The  stomach,  liver,  spleen,  and  pancreas  deviate  not 
infrequently  from  a healthy  state.  In  consequence 
of  remarking  the  hardness,  enlargement,  and  other  struct- 
ural alteration  in  the  liver,  the  late  Mr.  Abernethy,  to 
whom  the  department  of  surgery  owes  so  much,  was 
induced  to  believe  that  consumption  frequently  origina- 
ted in  a diseased  state  of  this  organ.  From  this  erro- 
neous view,  a mode  of  treatment  was  pursued  by  him, 
calculated  rather  to  aggravate  than  lessen  phthisical  symp- 
toms. By  too  great  a reliance  on  the  effects  of  mercu- 
ry, he  unfortunately  hastened  the  catastrophe  which  he 
sought  to  avert ; and  gave  the  sanction  of  his  high  au- 
thority to  a practice,  which,  for  several  reasons,  could 
not  be  attended  with  other  than  pernicious  effects.  It 
is  evident  that  he  never  reflected  upon  the  causes  to 
which  this  morbid  condition  of  the  liver  is  to  be  ascribed. 

In  consumption,  the  great  venous  trunks  are  always 
congested  in  a greater  or  less  degree.  The  cold  stages 


62  MORBID  APPEARANCES  OF  CONSUMPTION. 

of  the  hectic  paroxyms,  the  tuberculous  indurations,  the 
partial  pleurisies,  peripneumonies,  and  the  contraction  of 
the  chest  which  are  constantly  diminishing  the  capacity 
of  the  lungs,  retard  the  circulation  from  the  right  side 
of  the  heart  through  the  lungs  ; hence  a gorged  state 
of  the  venae  cavae,  and  congestion  of  the  liver,  the  in- 
separable consequences  of  the  preternatural  plenitude 
of  the  inferior  cava,  which  receives  the  blood  of  this 
the  largest  gland  in  the  system.  The  anatomist,  being 
aware  that  the  vena  portae  carries  the  residual  blood  of 
the  already  specified  organs  through  the  liver,  will  read- 
ily account  for  the  frequent  occurrence  of  the  morbid 
appearances  that  are  observable  after  death  in  these 
various  parts ; since  the  derangement  of  the  liver  will, 
it  need  hardly  be  said,  exercise  an  injurious  influence 
on  the  stomach,  spleen,  pancreas,  and  the  intestinal 
tube : nay,  it  is  by  no  means  uncommon  to  meet  with 
the  symptoms  of  subacute  inflammation  of  these  parts 
during  life.  The  frequency,  extent,  and  complication, 
however,  of  these  lesions  on  dissection,  are  chiefly  de- 
pendant on  the  treatment  that  has  been  pursued.  Should 
depletion  have  been  neglected,  these  morbid  affections 
will  necessarily  be  considerable  ; but  should  the  contra- 
ry course  have  been  judiciously  resorted  to,  they  will 
be  proportionably  rarer.  I may  mention,  by  way  of 
corollary  to  these  remarks,  that  serous  effusions  take 
place  as  a sequence  of  neglect  in  recurring  to  due  deple- 
tion, and  also,  in  many  instances,  as  the  result  of  debil- 
ity, and  are  the  proximate  cause  of  death.  These  may 
occur  to  a quintuple  extent ; for  example — in  the  brain, 
the  pericardium,  the  cellular  membrane  of  the  lungs, 
the  pleural  sacs,  and  the  peritonial  cavity.  From  repeat- 
ed observations  made  by  me,  and  which  have  never  yet 
been  subject  to  a single  exception,  I may  lay  it  down  as 
almost  an  invariable  rule,  that  an  oedematous  state  of  the 
feet  is  an  index  of  some  internal  effusion.  Indeed, 
whenever  I observe,  after  death,  and  before  dissection, 
that  the  extremities  are  swollen,  I feel  convinced  that 
the  presence  of  effusion  will  be  one  of  the  results  of 
the  examination.  As  one  of  the  complications  of  phthi- 
sis, I may  here  mention  a disposition  to  fistula,  which 
Bordeu  states  to  be  of  common  occurrence  ; but  accord- 
ing to  my  calculation,  I estimate  that  the  proportion 


MORBID  APPEARANCES  OF  CONSUMPTION.  63 

does  not  exceed  one  in  five  hundred  cases.  Yet  anal 
abscesses  are  far  from  being  infrequent:  on  examina- 
tion, however,  they  will  be  found  not  to  deserve  the 
name  of  true  fistulse.  Calcareous  deposites  are  occa- 
sionally found  loose,  in  some  large  cavities  of  the  lungs ; 
and  I entertain  no  doubt  from  having  seen  them  in 
imperfect  cicatrizations,  that  they  have  escaped  into 
these  excavations,  owing  to  the  destruction  of  their  con- 
taining cicatrice  by  ulceration.  The  general  formation 
of  these  deposites,  which  are  chiefly  composed  of  phos- 
phate of  lime,  and  of  traces  of  animal  matter,  is  not  a 
little  curious.  When  the  process  of  healing  is  imper- 
fectly performed,  and  the  constitution  of  the  individual 
is  possibly  inclined  to  a chalky  diathesis,  a calcareous 
secretion  is  substituted  for  the  cicatrization  that  remains 
to  be  finished,  and  a cure  of  the  part  is  thus  completed : 
and  l am  satisfied  that,  in  such  of  the  bronchial  glands 
as  contain  similar  concretions,  they  supply  the  room  of 
tuberculous  matter,  which  it  is  by  no  means  improbable 
is  partly  removed  by  absorption. 

Mr.  Abernethy  has  remarked  in  the  heart,  which  is 
generally  free  from  disease,  with  the  exception  of  slight 
dilatation  of  the  right  ventrical,  that  the  foramina  ihehesii 
are  frequently  enlarged.  However,  I have  never  yet 
met  with  any  appearances  to  verify  his  assertion. 

There  remain  many  observations  which  I would  gladly 
make  public,  on  the  morbid  appearances  observable  in 
consumption,  a department  of  inquiry  to  which  I have 
devoted  my  entire  professional  life  ; for  instance,  empy- 
ema, resulting  from  the  escape  of  tuberculous  matter 
into  the  cavity  of  the  chest,  pneumo-thorax,  gangrene, 
&c. : but,  as  I have  already  stated,  the  circumscribed 
limits  and  peculiar  nature  of  my  work  preclude  me 
from  indulging  my  wishes  on  this  my  favourite  theme. 
On  a future  occasion,  however,  it  is  not  improbable  that 
I may  have  to  olfer  a distinct  treatise  on  this  interesting 
subject. 

This  opportunity  will  be  presented  in  the  w^ork  on 
“ Diseases  of  the  Chest,”  to  which  I have  already  al- 
luded, and  which  I am  now  actively  engaged  in  prepar- 
ing. 


PROPHYLACTIC  TREATMENT, 


BY  WHICH  THE  DEVELOPMENT  OP  TUBERCLES  IN  THE  LUNGS  MAY* 

BE  PREVENTED  IN  PERSONS  LIABLE  THERETO  FROM  HEREDITARY 

PREDISPOSITION,  OR  A CACHECTIC  STATE  OF  THE  SYSTEM. 

Early  in  my  practice,  when  consulted  by  patients  of 
an  hereditary  predisposition  to  consumption,  it  was  usual 
with  me  to  recommend  a generous  invigorating  mode 
of  living,  and  daily  exercise  in  the  open  air,  with  a 
caution  to  avoid  every  thing  calculated  to  impair  the 
general  health.  If,  too,  it  were  in  the  patient’s  power 
to  avail  himself  frequently  of  change  of  air  and  scene, 
I generally  found  it  productive  of  considerable  benefit, 
both  in  a physical  and  mental  point  of  view.  The  ad- 
vantages derivable  from  short  excursions,  or,  still  bet- 
ter, voyages  by  sea,  always  invited  my  recommendation 
when  circumstances  rendered  them  available.  Impreg- 
nated as  the  sea  breezes  are  with  saline  particles,  they 
act,  I conceive,  as  stimulants  of  the  lungs  to  deeper  and 
more  frequent  inspiration,  and  thus  forward  the  enlarge- 
ment of  the  chest,  a point  to  which  I have  more  than 
once  adverted,  in  the  course  of  this  work,  as  of  primary 
importance.  They  may  also  be  regarded  as  possessed 
of  a tonic  power,  bracing  and  invigorating  the  surface 
of  the  body,  and,  by  continuous  sympathy,  exerting  a 
beneficial  influence  on  the  viscera,  especially  those  con- 
nected with  the  digestive  functions.  Another  strong  in- 
ducement to  recommend  a sea  voyage,  in  the  case  of 
persons  labouring  under  incipient  consumption,  is  the 
probability  of  the  patient’s  having  his  chest  expanded  in 
the  manner  described  above,  and  thus  increasing  the 
chances  of  his  contracting  some  variety  of  catarrh — 
hence  bidding  defiance  to  phthisis.  With  reference  to 
a generous  mode  of  living,  it  is  obvious  that  the  tenden- 
cy to  weakness,  exhibited  by  individuals  of  consump- 
tive constitution,  calls  for  a method  of  treatment  calcu- 
lated to  counteract  the  commencing  symptoms.  Par- 
ticular rules  and  limitations,  with  respect  to  the  dietetic 
management,  will  be  specified  under  the  head  of  diet. 
As  to  change  of  residence,  a singular  instance  of  its 


TREATMENT  OF  CONSUMPTION* 


65 


preventive  effects  occurred  some  years  ago  in  the  family 
of  a near  relative  of  mine,  formerly  colonel  of  a dis- 
tinguished cavalry  regiment,  who,  after  the  afflicting  loss 
of  two  grown-up  daughters  and  a son,  removed  with  his 
remaining  children  to  Tours.  Here  he  resided  for  five 
years ; at  the  expiration  of  which  period,  returning  to 
his  native  country,  and  to  the  neighbourhood  of  the 
place  in  which  the  disease  had  first  manifested  itself  in 
the  children  he  had  lost,  he  had  the  affliction  of  wit- 
nessing the  premature  deaths  of  three  other  members 
of  his  family  within  the  short  period  of  two  years. 

Celsus  says,  that  the  worst  air  for  the  patient  is  that 
which  has  given  rise  to  the  disease  ; to  which  we  may 
add,  that  to  consumptive  families  the  worst  locality  is 
that  in  which  the  disease  has  first  betrayed  itself. 

While  preparing  these  sheets  for  the  press,  I have 
met  with  a very  striking  exemplification  of  the  value  of 
distant  removal,  in  families  consumptively  inclined,  to 
those  members  whose  circumstances  have  called  from 
their  native  land.  Out  of  a family,  consisting  at  one 
period  of  eleven  individuals,  seven  remaining  here  have 
fallen  victims  to  consumption ; while  two,  who,  as  I 
have  been  given  to  understand,  displayed  the  same 
phthisical  constitution  as  these,  having  removed  to  some 
of  our  distant  settlements,  have  enjoyed  an  excellent 
state  of  health  for  many  years,  and  have  continued 
free  from  any  pectoral  complaint. 

Of  the  different  kinds  of  exercise,  I would  particu- 
larize running  and  riding  as  the  most  calculated  to  for- 
ward the  purposes  of  prevention ; indeed,  as  the  best 
general  prophylactics.  After  a quick  and  brisk  run, 
the  respiration  becomes  frequent  and  deep,  and  the 
panting  that  ensues  by  exercising  the  muscles  of  the 
chest,  favours  a healthy  development  of  that  part,  and 
enlarges  the  volume  of  the  lungs.  It  has  been  my 
universal  practice  to  recommend  a constant  attention  to 
this  healthy  exercise,  in  those  schools  I have  been  in 
the  habit  of  attending,  and  to  advise  the  preceptors  to 
promote  it  by  every  inducement  within  their  power; 
and  I have  never  been  disappointed  in  the  results  ex- 
perienced. Nor  are  its  happy  effects  confined  to  the 
mere  expansion  of  the  chest ; by  the  greater  portion  of 
air  thus  brought  into  contact  with  the  venous  system 

9 


66 


TREATMENT  OF  CONSUMPTION. 


the  blood  becomes  more  effectually  decarbonized,  the 
animal  heat  increased,  the  action  of  the  heart  more  vig- 
orous, and  the  multifarious  secretions  are  carried  on 
with  greater  energy. 

Riding,  which  stood  so  high  in  Sydenham’s  estima- 
tion, is  an  exercise  of  no  mean  value,  for  the  self-same 
reasons,  with  this  advantage,  that  it  yields  all  the  good 
effects  of  the  former,  unattended  with  its  fatigue.  To 
those,  however,  in  whom  consumption  has  decidedly 
appeared,  the  benefit  deriveable  from  this  mode  of  exer- 
cise, may,  perhaps,  be  enhanced  by  the  tendency  to  au 
upward  motion  imparted  to  the  lungs,  thus  disposing  to 
apposition  the  diseased  surfaces  in  the  upper  region  of 
the  chest.  Dr.  Carmichael  Smyth  has  advocated  the 
utility  of  swinging  as  an  exercise,  and  has  devoted  a 
treatise  to  its  supposed  merits.  This,  although  he  does 
not  explain  its  mode  of  operation,  undoubtedly  acts  in  a 
manner  similar  to  the  foregoing,  and,  notwithstanding 
I have  never  recommended  it,  it  may  not  be  unworthy 
of  trial  as  a prophylactic.  A strong  proof  of  the  advan-' 
tages  of  exercise  may  not  unwarrantably  be  sought  for 
in  the  probable  exemption  of  man,  in  a savage  state, 
from  the  ravages  of  this  disease.  Although  various  dis- 
orders are  mentioned  by  travellers  as  having  fallen  un- 
der their  observation,  I do  not  remember,  in  the  course 
of  my  reading,  to  have  met  with  any  notice  of  consump- 
tion, recorded  by  those  who  have  mingled  with  the 
savage  tribes  of  either  the  old  or  the  new  world ; at 
least,  among  the  more  active  races  of  uncivilized  man. 
Indeed,  it  would  be  wonderful  were  the  case  otherwise. 
Dependant  for  their  subsistence  on  incessant  vigilance 
and  vigorous  exertion ; constantly  engaged  in  the  toils 
of  the  chace,  or  animated  to  activity  by  the  animosities 
ever  subsisting  between  neighbouring  tribes,  however 
they  may  lapse  occasionally  into  habits  of  sloth  and  in- 
dolence, their  life  from  the  cradle  to  the  grave  must, 
generally  speaking,  be  calculated  to  call  forth  and  per- 
fect every  bodily  energy.  Free  from  the  restraints 
which  are  the  unavoidable  consequence  of  a state  of 
superior  intelligence, — neither  confined  to  the  manufac- 
tory, nor  chained  down  to  the  desk  of  the  counting-house, 
untrammelled  by  dress,  and  uncramped  by  the  various 
devices  to  which  either  fashion,  or  the  force  of  habit. 


TREATMENT  OF  CONSUMPTION. 


67 


renders  us  subservient  despite  the  dictates  of  reason, — 
the  savage  possesses  at  least  the  uncontrolled  use  of 
his  limbs  ; and  the  symmetry  usually  observed  in  him 
is  perhaps  the  best  index  of  the  health  he  enjoys.  If, 
too,  we  extend  our  course  of  reasoning  to  the  inferior 
race  of  animals,  and  observe  the  differences  existing 
between  them  in  their  wild  and  domestic  condition,  we 
shall  find  a singular  analogy  between  them  and  man. 
To  go  no  further  than  the  harmless  creature,  the  rabbit, 
I have  found,  in  the  course  of  my  researches  in  com- 
parative anatomy,  that  this  animal  frequently  dies  of 
consumption,  in  its  tame  state  ; but  I never  met  with  an 
instance  of  the  kind  in  the  wild  rabbit.  Perhaps  the 
benefit  of  exercise  cannot  be  better  exemplified  than  by 
way  of  contrast.  Swine,  proverbially  the  most  indolent 
of  animals,  are  also  the  most  subject  to  tuberculous  dis- 
ease ; hence  the  derivation  of  the  word  scrofula  from 
the  Latin  scrofa,  a swine  ; and  consumption  and  scrof- 
ula are  identically  the  same,  both  resulting  from  the 
presence  of  tubercles.  To  pursue  the  analogy,  another 
strong  instance  of  the  force  and  good  effects  of  exercise 
is  observable  in  the  race-horse,  the  hunter,  and  indeed 
in  all  of  this  class  that  are  subject  to  frequent  and  active 
exertion.  These  seldom  or  ever,  I believe,  are  found  to 
have  tubercles  in  the  lungs,  so  long  as  they  are  kept 
constantly  employed.  Many  illustrations  of  this  nature 
might  be  adduced,  but  sufficient  has  been  said  to  enable 
the  reader  to  extend  this  comparative  inquiry,  and  to 
confirm  the  high  value  which  I set  on  the  effects  of  ju- 
dicious and  well-regulated  exercise.  In  additional  con- 
firmation of  my  reliance  on  mechanical  modes  of  exer- 
cise, as  prophylactics,  I proceed  to  relate  a few  out  of 
numerous  cases  of  the  kind  I find  recorded  in  my  note- 
book. 

Case  1. — Some  few  years  back  I was  called  in  to  see 
the  eldest  son  of  a family  of  rank,  a boy  of  twelve  years 
of  age,  who,  when  I first  saw  him,  was  in  the  last  stage 
of  consumption,  to  which  a younger  member  of  the  same 
family,  whose  case  I had  the  opportunity  of  witnessing, 
had  previously  fallen  a victim.  As  was  expected,  the 
case  terminated  fatally ; and  on  examining  the  body, 
independently  of  the  diseased  state  of  the  lungs  which 
usually  occurs  in  consumption,  the  serous  surfaces  of 


68 


TREATMENT  OF  CONSUMPTION. 


the  chest,  as  well  as  of  the  abdomen,  were  studded  with 
innumerable  tubercles.  Some  of  these,  seated  in  the 
peritoneum  investing  the  intestinal  tube,  were  of  large 
size,  and  in  a state  of  crudity ; and  I traced  two  minute 
openings  in  the  ileum,  (formed,  I have  reason  to  believe, 
by  softened  tuberculous  matter,)  through  which  liquid 
foecal  contents  were  diffused  within  the  abdominal  cav- 
ity. This  part,  during  life,  was  of  ascitical  magnitude, 
and  fluctuated  on  percussion,  but  was  almost  devoid  of 
pain.  He  had  vomited  on  two  or  three  occasions  con- 
siderable quantities  of  liquid  matter,  emitting  a foecal 
odour,  and  similar  in  appearance  to  what  I afterward 
found  deposited  in  the  peritoneal  sac ; and  subsequent 
to  each  vomiting,  a perceptible  reduction  in  the  magni- 
tude of  the  abdomen  took  place.  This  circumstance 
would  induce  me  to  suppose,  judging  from  the  peculiar 
smell  and  appearance  of  the  ejected  fluid,  that  a portion 
had  been  returned  from  the  abdominal  cavity  into  the 
intestinal  canal,  whence,  by  inverted  action,  it  reached 
the  stomach  to  be  discharged  by  vomiting.  The  same 
appearances,  in  regard  to  extensive  tuberculous  deposite, 
with  the  exception  of  the  intestinal  perforation,  were, 
I was  given  to  understand,  presented  in  the  body  of  the 
younger  brother,  whose  death,  I have  already  mentioned, 
preceded  that  of  his  elder.  From  the  delicate  health 
of  the  remaining  members  of  the  family,  two  especially, 
joined  to  the  foregoing  signs  of  highly-charged  scrofu- 
lous habit,  it  was  apprehended  by  their  nearest  relatives 
that  the  disease  would  successively  pervade  the  whole 
family.  One,  however,  I felt  assured,  from  her  having 
had  for  two  years  a pulmonary  catarrh,  would  be  ex- 
empt from  the  dreaded  visitation.  Following  up  the 
plan  which  I had  ever  found  so  eminently  serviceable, 
I immediately  recommended  them  to  commence  a course 
of  inhalation.  For  this  purpose,  I ordered  that  tubes, 
of  diameters  varying  with  the  respective  ages  of  the 
patients,  should  be  prepared,  through  which  they  were 
directed  to  respire  twice  a day ; and  the  time  for  this 
process  was  gradually  extended,  until  it  occupied  half  an 
hour  morning  and  evening.  By  pursuing  this  plan  of 
treatment  their  chests  gradually  enlarged,  their  health 
became  surprisingly  amended,  and  a regularity  of  bow- 
els, without  the  aid  of  medicine,  was  soon  established. 


TREATMENT  OF  CONSUMPTION.  69 

It  may  here  be  advisable  to  explain  in  what  manner 
the  simple  process  of  inhalation,  while  it  expands  the 
pulmonary  apparatus,  at  the  same  time  regulates  the 
most  important  of  the  visceral  functions.  The  mere  ex- 
pansion of  the  lungs  in  the  first  instance  tends  indirectly 
to  remove  congestion  of  the  liver,  and  also  of  the  sto- 
mach, spleen,  pancreas,  and  intestinal  canal,  all  depend- 
ant on  the  more  free  circulation  of  the  blood  in  the  for- 
mer. The  biliary  as  well  as  the  great  salivary  secre- 
tion is  hereby  promoted  to  a healthy  activity.  Such 
morbid  irritability  of  the  mucous  membrane  of  the  sto- 
mach, as  may  be  present,  productive  of  indigestion,  is 
removed;  the  chyliferous  absorption  belonging  to  the 
small  intestines,  so  indispensable  to  life,  is  actively  car- 
ried on ; and  the  injurious  retention  of  excrementitious 
matter,  in  the  larger  intestines,  is  obviated  by  increased 
mucous  moisture,  and  accelerated  peristaltic  motion. 
It  were  easy,  did  I deem  it  essential,  to  point  out  at 
length  the  beneficial  effects  produced  on  other  secre- 
tions, and  to  explain  the  mode  by  which  inhalation  acts 
upon  that  of  the  kidneys  ; but  sufficient  has  been  stated 
to  enable  the  medical  man  to  draw  his  own  deductions 
in  these  particulars.  To  bring  the  history  of  this  fam- 
ily case  to  a close,  I have  the  pleasure  of  saying,  that 
a perfect  restoration  has  attended  my  endeavours,  and 
that  at  this  moment  these,  my  former  patients,  are  en- 
joying all  the  blessings  of  health. 

Case  2. — A young  gentleman  was  brought  to  my 
house,  by  the  secretary  of  an  incorporated  literary  in- 
stitution in  Lincoln’s  Inn  Fields,  labouring,  his  friends 
feared,  under  incipient  consumption.  His  conformation 
evidently  predisposed  him  to  phthisis ; and  his  chest  in 
particular  was  singularly  narrow^  and  slightly  deformed. 
I laid  down  the  plan  which  I conceived  it  would  be  most 
advisable  for  him  to  follow,  and  pointed  out  the  necessity 
of  strict  adherence  to  my  directions.  Inhalation,  of 
course,  formed  a prominent  feature  in  the  treatment  to 
be  observed.  It  so  happened,  that  I had  only  this  soli- 
tary opportunity  of  prescribing  for  him,  although  I could 
have  wished  to  see  him  from  time  to  time,  since 
there  are  circumstances  which  occasionally  render  it 
expedient  to  suspend  inhalation  for  a short  period,  and 
to  have  recourse  to  local  and^  other  treatment.  Not- 


70 


TREATMENT  OF  CONSUMPTION. 


withstanding  the  w^ant  of  this  opportunity  might  be  con- 
sidered unfavourable,  it  so  occurred,  to  my  great  satis- 
faction, that  meeting  the  gentleman  who  had  introduced 
the  youth,  about  eighteen  months  subsequent  to  his  con- 
sulting me,  and  of  course  inquiring  into  the  state  of  his 
health,  I found  that  he,  having  punctually  adhered  to 
my  instructions,  had  not  only  overcome  all  his  consump- 
tive symptoms  and  been  restored  to  robust  health,  but 
that  his  chest,  formerly  so  flat  and  confined,  had  altered 
in  shape,  was  considerably  enlarged,  and  was,  to  use 
the  expression  of  his  friend,  perfect  symmetry. 

Case  3. — Two  young  ladies,  of  adult  age,  vrere 
brought  to  towm  by  their  mother  in  the  middle  of  the 
year  1832,  for  the  purpose  of  taking  my  advice.  Four 
of  her  children  had,  she  stated,  been  attacked  by  con- 
sumption, within  a short  period  of  time,  and  had  fallen 
a prey  to  it.  Both,  when  I first  visited  them,  had  a 
short  hacking  cough,  with  undefined  pain  in  the  chest. 
In  the  eldest,  who  was  in  her  nineteenth  year,  the  mur- 
mur of  respiration  was  imperfect  in  the  top  of  the  right 
lung ; percussion  also,  on  the  centre  of  the  clavicle  of 
the  same  side,  yielded  a flat  sound.  My  impression  from 
these  signs  was,  that  a tuberculous  deposite  had  already 
taken  place.  Bronchophonism  was  distinctly  heard  by 
the  naked  ear ; and  it  was  plain,  from  the  absence  of 
any  variety  of  pectoriloquy,  that  no  softening  of  the 
mass,  so  as  to  form  a cavity,  had  occurred.  With  re- 
spect to  the  other  sister — since  the  sound  of  her  respi- 
ration was  natural,  and  no  bronchial  affection  whatever 
was  indicated,  yet  as  she  had  occasional  cough,  and 
had  had,  as  I was  informed,  slight  hsemoptysis — I con- 
ceived that  a few  solitary  tubercles  might  possibly  exist 
in  her  lungs,  irritating  the  pulmonary  tissue  like  the  thorn 
of  Van  Helmont.  These  symptoms  considered,  I com- 
menced with  local  blood-letting,  and  the  exhibition  of  nitre 
in  doses  of  a scruple,  &c. ; after  which,  my  chief  reli- 
ance was  on  inhalation.  They  persevered  in  a course  of 
this  for  some  months,  inhaling,  according  to  my  custo- 
mary directions,  twice  a day,  varying  the  diameter  of 
the  tubes  employed,  since  occasionally  pain  arose  from 
the  expansive  process  being  too  powerful.  Indeed,  the 
liability  to  pulmonary  engorgement,  from  using  tubes  of 
too  small  a diameter,  points  out  the  necessity  for  the 


TREATMENT  OF  CONSUMPTION.  ' " 71 

constant  superintendence  of  the  practitioner,  skilled  in 
the  auscultative  exploration  of  the  chest.  ' One  circum- 
stance, perhaps,  should  not  be  passed  over,  as  exhibit- 
ing an  additional  proof  of  the  good  effects  of  inhalation 
on  the  general  health.  The  periodical  uterine  secretion 
of  the  elder  of  these  young  ladies  having  been  sup- 
pressed for  some  months,  she  recovered  in  the  course 
of  a few  weeks  the  usual  feminine  habit,  which  subse- 
quently continued  underanged.  Nothing  of  further  mo- 
ment occurred  in  the  course  of  these  cases.  Continuing 
gradually  to  improve,  the  younger  became  perfectly  re- 
stored to  health ; and  the  elder,  although  the  respiration 
in  the  upper  lobe  of  the  right  lung  is  not  so  perfect  as  I 
could  desire,  still,  from  the  general  expansion  which 
the  pulmonary  tissue  underwent  in  all  other  parts,  and 
the  probability  that  in  time  black  pulmonary  secretion 
will  form  around  the  existing  nodules,  so  as  to  isolate 
them  in  the  manner  I have  fully  described  in  the  chap- 
ter on  morbid  appearances,  I consider  as  entirely  free 
from  all  danger  of  any  new  formation  of  tuberculous 
matter. 

The  value  of  exercise,  in  checking  and  removing 
symptoms  of  incipient  phthisis,  is,  in  my  opinion,  so 
great,  that  I am  induced  to  dwell  at  some  length  upon 
this  part  of  my  subject.  Those  musicians  whose  pro- 
fession it  is  to  play  upon  wind  instruments  are  in  general 
supposed  to  be  peculiarly  subject  to  pulmonary  com- 
plaints ; perhaps  not  inaccurately  so : yet,  I am  not 
aw'are  that  any  detailed  or  circumstantial  explanation 
has  been  given  of  the  mode  through  which  injurious 
effects  arise  from  the  use  of  such  instruments.  Who- 
ever will  take  the  trouble  to  watch  attentively  a player 
on  the  flute,  or  clarionet,  &c.,  will  find,  that  although 
the  performer  seemingly  inspires  and  expires  frequently 
and  fully,  yet  that,  in  point  of  fact,  he  often  makes  sev- 
eral consecutive  expirations  to  one  inspiration.  Thus 
his  breathing,  so  far  from  being  advantageous,  and  so 
far  from  'developing  the  lungs,  as  I have  previously  de- 
clared well-regulated  mechanical  exercise  will  ever  do, 
is  indeed  so  irregular  and  furtive,  that  it  produces  effects 
entirely  the  reverse,  narrowing  the  chest,  and  confining 
the  volume  of  the  lungs  : indeed,  it  favours  that  dimin- 
ished size  of  the  respiratory  apparatus  which  engenders 


72  TREATMENT  OF  CONSUMPTION. 

a tendency  to  consumption.  What  I may  not  inaptly 
term  a wholesale  case  occurred  some  years  ago,  illus- 
trative of  the  foregoing  remarks.  The  leader  of  an  itin- 
erant band  of  musicians  applied  to  me  in  behalf  of  him- 
self and  followers,  to  know  what  method  they  should 
pursue  to  avert  the  threatening  appearances,  which  they 
considered  would  ultimately  lead  to  confirmed  pulmo- 
nary affection.  I advised,  that  after  their  musical  en- 
tertainment for  the  time  being  was  concluded,  they 
should  always  take  a long  and  quick  run,  or  else  carry 
walking  sticks,  perforated  longitudinally,  through  which 
they  might  respire,  and  thus  compensate  their  previous 
irregularity  in  breathing.  Ludicrous  as  the  idea  may 
appear,  of  a set  of  men  scampering  off,  after  an  exhi- 
bition of  their  scientific  powers,  these  poor  fellows  had 
the  good  sense  to  perceive  the  advantage  of  pursuing 
my  advice ; and  I have  subsequently  learned  that  they 
have  experienced  its  happy  influence.  It  has  been  my 
uniform  practice  indeed,  in  similar  instances,  to  recom- 
mend a similar  proceeding,  and  the  benefit  has,  I trust, 
been  widely  diffused.  Before  proceeding  further  in  this 
chapter,  it  may  not  be  irrelevant  to  notice,  that  protracted 
indisposition,  whether  arising  from  mental  or  bodily 
causes,  is  productive  of  diminution  of  ,the  chest ; the 
general  debility  causing  local  muscular  weakness,  and 
this  being  more  particularly  the  case  in  the  muscles  of 
inspiration.  The  lungs,  thus  compressed,  are  of  course 
favourable  to  the  development  of  tubercles ; as  well 
as  to  pleurisies,  which,  according  to  a great  authority, 
M.  Laennec,  are  the  cause  of  permanent  contraction  of 
the  chest  in  consumption.  But  it  should  be  borne  in 
mind,  that  this  writer  is  utterly  mistaken  when  he  as- 
serts that  the  endeavours  of  nature  to  cure  phthisis  ori- 
ginate the  same  phenomenon. 

The  truth  is,  the  contrary  is  the  fact ; since,  on  ex- 
amination of  the  lungs  of  persons  who  have  recovered 
from  consumption,  we  almost  invariably  find  their  lungs 
voluminous,  and  their  chests  of  increased  capacity. — 
When  individuals  labour  under  chronic  or  incurable 
diseases  of  any  kind,  whether  medical  or  surgical,  and 
the  constitution  is  much  impaired  by  the  continuance  of 
ill  health,  consumption  is  peculiarly  prone  to  manifest 
itself : but  should  they  have  been  subject  for  any  length 


TREA.TMENT  OF  CONSUMPTION.  73 

of  time  to  catarrhal,  asthmatic,  or  cardiacal  affections,  I 
have  long-  observed  that  they  enjoy  a complete  immuni- 
ty from  tuberculous  attacks,  and  hence  cannot  become 
consumptive.  Therefore,  in  imitation  of  my  own  prac- 
tice, I would  earnestly  recommend  the  physician,  as 
well  as  surgeon,  to  exercise  the  chest  by  means  of  in- 
halation; and  the  result  would  be  to  ward  off  any 
secondary  complaint,  such  as  consumption,  which  so 
commonly  supervenes  to  shorten  lives  that  otherwise 
might  have  been  indefinitely  prolonged.  To  strengthen 
my  assertions  respecting  the  beneficial  results  arising 
from  the  manifestations  of  catarrh,  in  persons  suffering 
from  incurable  complaints,  I could  give  from  my  case-book, 
and  indeed  from  memory  as  well,  innumerable  cases 
confirmatory  of  my  views : but  a few  will  suffice  to 
show  that  I do  not  exaggerate  its  happy  influence. 

Case  4. — Sarah  Jackson,  aged  forty-eight,  applied 
four  years  ago  to  the  Infirmary  for  Asthma,  Consump- 
tion, &c.,  in  consequence  of  consumptive  symptoms  ; 
such  as  hectic  fever,  frequent  pulse,  violent  cough,  with 
copious  puriform  and  sometimes  sanguineous  expectora- 
tion, profuse  nocturnal  perspirations,  and,  as  might  be 
expected,  great  emaciation  and  debility.  Her  habit  had 
long  been  feeble : this  had  been  in  the  first  place  in- 
duced by  a cancerous  affection  of  the  womb,  destruct- 
ive of  the  cervix  and  a portion  of  its  body,  and  which 
had  produced  malignant  ulceration  of  the  upper  part 
of  the  vagina,  accompanied  with  racking  pain,  fetid 
sanies,  and  other  exhausting  discharges  attendant  on 
schirrous  uterine  disease.  It  was  not  till  she  had  been 
an  out-patient  at  the  infirmary  for  some  time  that  I was 
made  acquainted  with  the  above  alarming  cancerous 
state.  This  of  course  appeared  a fearful  complication 
of  disease,  and,  in  fact,  made  me  regard  the  case  as 
almost  hopeless.  However,  by  means  of  small  local 
bleedings,  at  times  from  the  chest,  and  occasionally 
from  the  neighbourhood  of  the  uterus,  together  with  the 
exhibition  of  saline  medicines,  conjoined  with  tartar 
emetic  in  small  quantity,,  and  aluminous  and  other  in- 
jections for  the  womb,  I succeeded  in  entirely  removing 
her  constitutional  disorder,  and  in  greatly  mitigating,  the 
disease  of  the  chest,  as  well  as  that  of  the  uterus.  Now, 
whether  it  was  owing  to  her  own  imprudence,  in  im- 

10 


74  TREATMENT  OF  CONSUMPTION. 

properly  using  the  injections  too  cold,  or  from  incautious 
exposure  to  the  weather  during  the  prevalence  of  east- 
erly winds,  a severe  bronchial  affection  took  place,  in 
which  was  well  marked  sonorous  and  sibilant  rattle. — 
Excepting  mucilaginous  and  demulcent  drinks,  with 
small  doses  of  nitre,  she  had  very  little  medicine  ad- 
ministered to  her.  Indeed,  I hailed  this  adscititious 
complaint,  notwithstanding  her  much  embarrassed  breath- 
ing and  distressing  cough,  as  the  most  fortunate  circum- 
stance that  could  have  befallen  her ; and  was  therefore 
inclined  to  let  nature  work,  carefully  watching  every 
indication,  and  desirous  to  assist  rather  than  to  inter- 
fere with  her  operations.  It  is  superfluous  to  enter  into 
all  the  minutise  of  this  patient’s  treatment ; suffice  it  to 
say,  that  a permanent  catarrh  was  established,  thus  at 
once  arresting  the  progress  of  consumption,  and  daily 
adding  to  her  security  from  all  danger  of  relapse.  Nor 
was  this  the  sole  advantage  resulting  from  the  super- 
vention of  a bronchial  complaint.  By  the  improvement 
which  the  patient’s  general  health  experienced,  from 
the  successful  termination  given  to  the  consumptive 
symptoms,  the  uterine  malady  has  increased  but  little, 
which,  aggravated  by  the  supervening  phthisis,  would, 
without  the  ingression  of  the  last  of  this  ternary  com- 
plication, most  probably  have  long  since  proved  fataL 
Thus,  in  this  instance,  as  well  as  in  many  others  of  no 
dissimilar  nature,  which  it  were  easy  to  adduce,  we  have 
proof  corroborative  of  the  fact,  that  the  supervening 
catarrh,  occurring  spontaneously,  will  not  only  give  a 
favourable  turn  to  the  course  of  consumption,  but  be 
instrumental  in  delaying  the  advance  of  an  incurable 
disease.  So  well  defined  is  this  case,  and  so  strong  a 
proof  does  it  afford  of  the  efficacy  of  the  practical  treat- 
ment which  it  is  my  chief  object  to  point  out,  that  I 
deem  it  necessary  to  demonstrate  beyond  doubt  the 
consumptive  condition  of  this  patient ; and  I therefore 
am  anxious  to  add,  that  my  opinion  was  not  grounded 
merely  upon  the  common  symptoms  of  phthisis,  but 
upon  the  more  certain  indices  affi)rded  by  physical  phe- 
nomena. This  female,  whose  employment  is  that  of  a 
nurse,  has,  I understand,  communicated  her  improved 
health  to  Mn  White,  surgeon  to  the  Westminister  Hos- 
pital, and  also  to  Dr.  Borett,  a Polish  physician,  and 


TREATMENT  OF  CONSUMPTION. 


75 


others,  who,  in  conjunction  with  myself,  carefully  ascer- 
tained the  nature  of  her  pectoral  as  well  as  uterine  dis- 
orders, and  can  bear  testimony  to  the  order  in  which 
they  occurred. 

Case  5. — Mr.  C.  W.,  from  the  neighbourhood  of 
Rumford,  applied  to  me  in  February,  1828,  for  a com- 
plaint of  the  chest.  He  had  been  for  some  months  ex- 
pectorating muco-purulent  matter  in  considerable  quan- 
tities ; through  this,  as  well  as  profuse  perspirations, 
and  an  occasional  febrile  state,  he  had  become  exces- 
sively debilitated  and  attenuated.  After  pursuing  my 
advice  for  a short  time,  he  lost  his  more  formidable  symp- 
toms ; and  there  were  merely  left  slight  cough,  and  an 
oppressive  wheezing,  which,  at  times,  would  compel 
him  to  leave  his  bed  about  two  hours  after  midnight 
Though  he  considered  himself  well  for  nearly  five 
years  after  this,  I have  nevertheless  grounds  for  belief, 
as  this  was  a cured  consumptive  case,  and  as  he  exhib- 
ited slight  symptoms  of  emphysema,  that  his  lungs  must 
have  been  more  or  less  affected  throughout  this  space 
of  time  with  some  bronchial  irritation,  though  he  had 
but  little  cough.  Being  called  in  to  this  gentleman 
about  three  years  ago,  as  apprehensions  w'ere  enter- 
tained, from  certain  pulmonary  indications,  of  his  re- 
lapsing into  the  state  from  w^hich  I had  formerly  relieved 
him,  I ascertained  by  the  ear  that  a bronchial  affection 
had  been  established,  which,  from  my  recollection  of 
the  peculiarities  of  his  ailments,  and  my  having  regard- 
ed his  case  as  one  of  cured  consumption,  I felt  satisfied, 
previous  to  auscultation,  would  prove  to  be  the  fact. 
Pointing  out  this  condition  of  his  patient  to  that  most 
intelligent  practitioner,  Mr.  Sewell,  I assured  him  that 
he  need  not  have  contemplated  a recurrence  of  con- 
sumption, though  such  might  not  unreasonably  be  ap- 
prehended from  a malignant  schirrous  affection,  which 
had  made  its  appearance  a year  previously,  and  had 
committed  extensive  ravages  on  the  rectum,  perineum, 
and  adjoining  parts,  for  which  the  most  celebrated  sur- 
gical advice  was  taken.  From  the  ill  health  induced 
by  the  foregoing  destructive  malady,  the  chances  of  his 
having  consumption  were  considerably  augmented ; but 
owing  to  the  protection  afforded  by  chronic  catarrh,  as 
I have  often  reiterated,  the  patient  is  placed  beyond  the 


76  TREATMENT  OF  CONSUMPTION. 

reach  of  that  most  common  and  fatal  of  human  dis- 
eases— pulmonary  consumption. 

Case  6. — However  Anti-Malthusian  the  doctrine 
may  be,  yet  as  it  is  in  accordance  with  the  law,  and 
may  likewise  be  regarded  as  a special  dispensation  of 
nature,  I do  not  scruple  to  advance  it  as  my  opinion, 
that  many  cases  of  threatened,  or  indeed  actual  con- 
sumption, in  the  female,  may  be  warded  off  by  a timely 
compliance  with  the  first  benignant  ordination  given  to 
our  first  parents — marriage.  In  order  fully  to  explain 
how  the  benefit  arises,  and  in  what  manner  the  bless- 
ings of  matrimony, — for  such  I believe,  despite  the  late 
talented  professor  just  alluded  to,  they  are  still  called, 
— operate,  I shall  cite  one  from  a variety  of  similar  ca- 
ses. Mrs.  E.  S.,  aged  thirty-eight,  made  application  to 
me,  in  the  winter  of  1827,  for  a painful  state  of  the 
chest,  with  oppressed  breathing  and  severe  cough,  with 
expectoration  of  blood,  mixed  with  frothy,  yellow  matter. 
She  likewise  complained  of  profuse  perspiration^,  fol- 
lowed by  emaciation  and  extreme  debility.  Among 
other  physical  signs,  pectoriloquism  was  distinctly  heard 
by  the  naked  ear  underneath  the  second  and  third  ribs 
of  the  right  side.  When  she  first  came  to  me  she  laboured 
under  much  depression  and  anxiety  wfith  respect  to  her 
state,  not  only  from  her  having  lost  two  sisters  by  the 
same  disease,  but  from  her  husband’s  having  inadvert- 
ently communicated  to  her  the  opinion  of  a respectable 
medical  practitioner  of  Great  Ormond  street,  who,  to 
use  her  own  words,  had  unreservedly  stated  to  him, 
‘Hhat  no  power  on  earth  could  save  her  life.”  My  opin- 
ion at  first  was  also  of  an  unfavourable  kind.  The  ex- 
perience of  a few  days,  however,  since  the  most  distress- 
ing symptoms  of  the  case  yielded  to  remedial  treatment, 
induced  me  to  entertain  hopes.  These  hopes  became 
certainty  when  I discovered  that  she  was  in  a state  of 
pregnancy,  for  I had  long  noticed  that  the  constantly 
increasing  magnitude  of  the  womb  exerts  a powerful 
influence  in  suspending,  and  still  further  in  curing  tu- 
bercular phthisis.  This  circumstance  is  not  brought 
forward  as  any  novelty  to  the  profession,  but  simply  as 
affording  an  opportunity  of  explaining  the  process  by 
which  the  gravid  uterus  accomplishes  so  favourable  an 
end.  The  hitherto  received  opinion  is,  that  a diversion 


TREATMENT  OF  CONSUMPTION. 


77 


of  morbid  action  from  the  lungs  takes  place,  through 
the  necessary  afflux  of  sanguineous  fluid  to  the  womb 
and  its  embryo,  thus  arresting  disease  ; but  I conceive 
that  this  mode  of  accounting  for  the  cures  effected  is 
utterly  vague  and  unsatisfactory.  In  such  cases,  the 
suspension  of  existing  disease  in  the  lungs,  and  indeed 
the  permanent  removal  of  the  constitutional  symptoms 
of  phthisis,  are  no  doubt  effected  by  the  encroachment 
made  on  the  chest  from  below  upward  by  the  pressure 
beneath  the  diaphragm,  which  has  the  effect  of  bringing 
in  apposition  the  inferior  and  superior  surfaces  of  the 
pulmonary  cavities,  so  as  to  unite  them.  This  view  of 
mine  is  borne  out  hy  Xhe post  mortem  appearances  which 
I have  witnessed  in  those  who  had  recovered  from  con- 
sumption while  in  a pregnant  state.  In  not  a few  ex- 
aminations of  this  kind,  I have  noticed  that  the  inter- 
nal cicatrizations  of  the  healed  lungs  were  transverse 
or  horizontal,  thus  proving  that  the  progressive  pressure 
upward,  in  the  direction  of  the  diseased  summit,  had 
been  the  sole  cause  of  that  union  to  which  the  disease 
has,  in  a great  measure,  owed  its  cure.  This  mode  of 
explaining  the  cure  appears  to  me  much  less  hypothet- 
ical than  the  generally  received  doctrine,  since  it  is  based 
on  proofs  derived  equally  from  anatomical  and  patholo- 
gical research ; yet  I do  not  wholly  dissent  from  the 
customary  view  of  the  subject,  the  cure  being  indisput- 
ably, in  many  instances,  consequent  on  the  determina- 
tion of  blood  to  the  uterus,  thus  diminishing  to  a certain 
extent  a local  disease,  and  allowing,  by  this  diminution, 
the  supervention  of  subacute  bronchial  irritation.  This 
last  accident  is,  in  no  slight  degree,  perhaps,  favoured 
by  the  horizontal  enlargement  of  the  lungs,  especially 
of  the  lower  lobes.  Though  instances  of  recovery, 
attendant  on  pregnancy  supervening  to  consumption,  are 
numerous,  yet  as  cases  notwithstanding  happen  in 
which  a cure  has  not  been  effected,  I think  it  essential 
to  indicate  one  or  two  reasons  for  such  occurrence. 

First,  we  cannot  be  surprised,  when  pregnancy  takes 
place  in  an  advanced  stage  of  the  disease,  at  not  meet- 
ing with  the  usual  effects,  and  a second  reason  that 
may  be  assigned  for  death  following  what  might  other- 
wise be  regarded  as  a case  of  cured  consumption,  may 
be  found  in  the  absence  of  chronic  catarrh ; or  in  the 


78  TREATMENT  OF  CONSUMPTION. 

production  of  a fresh  crop  of  tubercles  by  ill  health, 
after  cicatrization  has  taken  place.  Having  thus  pur- 
posely digressed,  in  order  to  explain  my  views  of  the 
sanatory  influence  of  pregnancy,  I hasten  to  the  con- 
clusion of  the  present  case.  Since  Mrs.  E.  S.  first  be- 
came my  patient  she  has  had  four  children,  now  alive ; 
and  with  the  exception  of  a discharge  of  blood  and 
muco-purulent  matter,  that  continued  for  a week,  about 
five  years  ago,  possibly  expectorated  from  some  imper- 
fectly healed  cavity  of  long  date,  she  has  had  no  recur- 
rence of  her  former  formidable  complaint.  During  the 
last  two  years  she  has  been  free  from  cough  ; and,  with 
the  exception  of  slight  catarrh,  for  a time  attended  with 
abundant  pituitous  discharge,  she  is  in  the  enjoyment 
of  better  health  than  she  has  been  in  for  the  last  ten 
years.  At  present  I consider  her  as  perfectly  secured 
against  a relapse  into  her  former  state,  for  two  reasons 
— the  partial  cicatrizations  which  evidently  took  place 
during  pregnancy,  and  the  existence  of  emphysematous, 
and  voluminous  lungs — the  first  discoverable  by  respi- 
ration denoting  that  state,  and  the  second  being  its  cer- 
tain consequence.  It  cannot,  I think,  be  wondered  at, 
that  having  repeatedly  witnessed  the  fortunate  results 
arising  from  the  pregnant  state,  I should  have  some 
years  ago  ventured  to  suggest  to  the  unmarried  con- 
sumptive female  the  propriety  or  necessity  of  matrimo- 
ny where  from  the  circumstance  of  existing  reciprocal 
attachment  such  an  engagement  could  be  happily  en- 
tered into. 

I have  previously  mentioned  that  asthmatic,  catarrhal, 
and  cardiacal  individuals  are  exempt  from  all  danger  of 
pulmonary  consumption;  and  to  these  I may  subjoin 
persons  affected  wdth  diseases  of  the  convulsive  kind, 
such  as  hysteria,  epilepsy,  or,  in  truth,  all  in  which  a pro- 
longed, forcible  retention  of  the  breath  is  frequently 
seen.  This  circumstance,  in  patients  of  this  description, 
must  be  accounted  for  in  the  manner  already  explained, 
when  dwelling  upon  the  benefits  arising  from  the  me- 
chanical extensibility  of  the  air  cells  by  inhalation. 

Before  bringing  these  remarks  on  the  prophylactic 
treatment  of  phthisis  to  a close,  there  remain  a few 
general  observations,  which  spring  as  much,  or  nearly 
so,  from  experience  in  my  own  person,  as  from  my  at- 


TREATMENT  OF  CONSUMPTION.  79 

tention  to  the  cases  of  others.  In  the  foregoing  portion 
of  my  work,  I have  advised  a generous  mode  of  living, 
as  among  the  preventives  of  this  disease ; and  in  pe- 
culiar circumstances  I would  even  recommend  the  use 
— of  course  the  cautious  use — of  wine,  sound  home- 
brewed malt  liquors,  and  occasionally  of  other  stimulants. 
I now  allude  to  a failure  of  health,  the  forerunner  of 
consumptive  attack,  induced  by  trouble  of  mind,  to  which 
I lament  to  say  mimbers  fall  lingering  victims.  It  has 
been  my  misfortune  to  witness,  in  the  course  of  my 
practice,  but  too  many  instances  of  the  maladies  engen- 
dered by  ‘‘  a mind  diseased.”  Well  has  the  poet  of  na- 
ture remarked  this,  among  his  aggregate  of  human 
ills,  when  he  mentions  ‘‘  the  law’s  delay,”  than  which  I 
know  not  a greater  destroyer  of  peace  of  mind,  and 
with  it,  of  the  body’s  health.  We  are  accustomed  to 
look  back  with  horror  on  the  proceedings  recorded  by 
historians  as  having  taken  place  in  that  iniquitous  court 
which  went  under  the  name  of  the  Star  Chamber  : how 
then,  judging  by  analogy,  will  our  posterity  execrate 
the  records  left  them  of  the  practice  of  the  Court  of 
Chancery  ! They  will  there  read  a piteous  tale  of  just- 
ice withheld, — of  hope,  the  brightest  boon  of  heaven, 
extended  and  protracted,  until  to  look  forward  is  to  ex- 
claim, with  Lear,  ‘‘  O ! that  way  madness  lies.”  The 
ghastly  train  of  diseases,  consumption,  cancer,  and 
other  fell  destroyers  of  the  human  race,  which  I have 
seen  brought  on  the  wretched  victims  of  the  procrasti- 
nation, until  recently  the  characteristic  of  this  court, 
leads  me,  in  common  with  the  general  voice,  to  reflect 
with  gratitude  on  the  change  that  has  been  effected  by 
the  wise  energy  of  one  master  spirit.  Had  the  reforms, 
introduced  by  him,  been  adopted  even  a few  years 
sooner,  how  many  a fair  fabric  of  human  happiness 
would  have  been  spared  that  now  lies  dismantled  and 
overthrown  ! To  return  from  this  digression.  On  oc- 
casions when  the  mind  is  kept  constantly  on  the  rack, 
I consider  it  not  unadvisable  to  allow  a comparative 
freedom  in  point  of  living  ; but  I must  add  a caution, 
with  respect  to  patients  of  the  weaker  sex,  to  whom  this 
freedom,  limited  as  I have  stated  it  should  be,  must  be 
still  more  sparingly  granted.  The  difference  in  strength, 
both  mental  and  physical,  calls  for  strict  attention  to 
this  distinc‘tion. 


TREATMENT  OF  CONSUMPTION. 


There  are  but  two  modes  by  which  we  can  hope  to 
cure  this  disease : the  one  is  by  rendering  it  chronic, 
and  the  other  by  artificially  enlarging  tliose  portions  of 
the  lungs  which  are  pervious  to  air.  In  the  first  we 
endeavour  to  effect  an  absence  of  constitutional  disorder; 
but,  after  this  change  is  effected,  there  may  still  remain 
for  an  indefinite  period  one  or  more  cavities  uncicatrized, 
with  lining  membrane,  partly  semi-cartilaginous,  or  of 
such  condensed  and  insensible  structure  as  to  be 
productive  of  little  inconvenience,  if  we  except  occasional 
cough  and  some  haemorrhage,  which  last  occurs  at  long 
intervals,  and  rarely  to  a great  extent.  In  the  second, 
there  is  produced  what  is  invariably  seen  when  nature 
or  art  has  effected  a cure — an  enlargement  of  the 
vesicular  structure  of  the  lungs,  and  subsequently  a 
gradual  healing  of  the  tuberculous  excavations. 

It  has  always  been  my  great  aim  to  put  an  end,  as 
early  as  possible,  to  the  symptoms  of  hectic  fever.  This 
I have  successfully  accomplished,  in  many  instances,  by 
employing  moderate  anti-phlogistic  means ; among 
which,  I may  first  mention  general  and  local  blood-let- 
ting. It  is  astonishing  how  great  is  the  relief  afforded 
by  even  six  or  eight  leeches,  applied  to  the  chest  while 
the  patient  is  labouring  under  the  hectic  paroxysm.  It 
was  early  my  practice  to  bleed  two  or  three  times  from 
the  arm,  as  we  thus  interrupt  the  noon-day  chills,  even- 
ing fever,  and  the  nightly  perspirations : and  when  the 
abstraction  of  blood  by  the  lancet  is  employed  early, 
(acute  inflammation  being  absent,)  and  in  a quantity 
rarely  exceeding  five  or  six  ounces  at  a time,  weakness 
is  seldom  complained  of ; on  the  contrary,  the  greatest 
relief  is  experienced.  The  weight  and  erratic  pains  of 
the  chest,  distressing  cough,  shortness  of  breath,  and 
irritability  of  the  stomach,  are  greatly  lessened.  It  has 
long  appeared  to  me  that  the  necessity  for  the  abstrac- 
tion of  blood  has  not  been  judiciously  considered  ; other- 
wise, I should  not  be  consulted  by  so  many  consumptive 


TREATMENT  OF  CONSUMPTION.  8l 

individuals,  in  whom  the  disease  has  gone  on  unpalliated 
by  any  sanguineous  depletion. 

This  consideration  becomes  the  more  important  when 
we  reflect  how  liable  to  produce  a certain  degree  of 
venous  congestion  are  the  chilly  fits,  which  are  of  daily 
occurrence,  as  well  as  tubercular  deposites  and  engorge- 
ments in  the  lungs  themselves,  the  bulk  of  which  is 
gradually  undergoing  a diminution  by  the  contraction  of 
the  chest.  The  blood  of  the  right  ventricle  of  the  heart 
not  finding  a ready  passage  through  the  lungs,  afflicted 
as  above  mentioned,  causes  a preternatural  quantity  of 
the  same  fluid  in  the  adjoining  auricle,  and  especially  in 
the  tw’o  great  veins  opening  into  it.  The  consequences 
of  this  state  are  head-ache,  owing  to  interruption  of  the 
free  return  of  blood  from  the  head ; pulmonary  engorge- 
ment, through  the  difficulty  the  bronchial  veins  experi- 
ence in  transmitting  their  blood,  ‘by  either  its  direct  or 
circuitous  course,  into  the  vena  azygos  ; and  serious  de- 
rangement, or  actual  disease,  of  the  most  important  vis- 
cera of  the  abdomen.  The  superior  cava,  prenaturally 
full  of  blood,  will,  by  retarding  that  fluid  in  the  jugular 
veins,  produce  pain  in  the  head ; and,  by  a similar  inter- 
ruption to  the  circulation  of  the  vena  azygos,  besides  in- 
terfering with  the  free  return  of  the  blood  into  the  bron- 
chial veins,  it  will  in  some  degree  impair  the  activity  of 
the  kidneys  ; the  due  return  of  the  effete  blood  of  which 
organs  depends  on  the  freedom  with  which  it  is  con- 
veyed from  the  vena  azygos  into  the  vena  cava  superior. 

The  moderate  abstraction  of  blood,  occasionally,  pre- 
vents that  congestion  in  the  floating  viscera  of  the  ab- 
domen which  gives  rise  to  diarrhoea,  irritability  of  the 
stomach,  and  effusion  from  the  serous  membrane  invest- 
ing them,  which  at  times  occurs.  It  has,  indeed,  an 
excellent  effect  in  securing  freedom  to  the  hepatic  cir- 
culation ; and  thus  all  the  parts,  whose  venous  circula- 
tion passes  through  the  liver  by  the  vena  portae,  are  long 
preserved  in  a state  of  integrity.  Besides  the  great  ex- 
emption from  diarrhoea  which  this  practice  affords,  the 
colliquative  perspirations  likewise  are  either  greatly 
lessened,  or  for  no  inconsiderable  period  wholly  removed. 
Where  the  disease  is  not  of  such  long  duration  as  to  be 
attended  by  much  emaciation  and  debility,  I would 
advise  general  blood-letting,  to  the  extent  of  four  or  six 

11 


82  TREATMENT  OF  CONSUMPTION. 

ounces,  to  be  performed  three  or  four  times  during  the 
presence  of  hectic  fever ; allowing,  of  course,  the  patient 
being  better,  a reasonable  time  to  elapse  before  he  be 
again  subjected  to  this  operation.  In  consumption,  par- 
ticularly in  its  early  stage,  I find  patients  generally  say 
they  are  strengthened,  rather  than  weakened,  when  four 
or  five  ounces  of  blood  are  taken  at  intervals  of  a few 
days.  After  the  constitutional  fever  has  been  in  this 
manner  interrupted,  if  it  seems  shortly  after  disposed  to 
return,  we  may  again  ward  it  off  by  applying  six  or 
eight  leeches  on  the  summit  of  the  chest  just  beneath 
the  clavicles.  In  my  opinion,  they  are  best  applied  on 
the  upper  part  of  the  chest,  since  it  is  there  that  the 
tubercular  affection  first  commences.  By  thus  alterna- 
ting the  general  and  local  bleedings,  we  husband  the 
patient’s  strength,  while  at  the  same  time  we  mitigate 
the  most  distressing  symptoms  of  his  disorder.  Cases 
are  at  times  met  with,  in  which  the  lancet  may  be  used 
with  some  degree  of  freedom.  For  example:  when 
signs  of  pleuritic  or  pneumonic  inflammation  are  pre- 
sent, and  when  hsemoptical  discharges  are  attended  with 
much  oppression,  pain,  and  heat  in  the  chest.  I have 
not  seen  it  noticed,  that,  in  the  absence  of  acute  inflam- 
mation, the  blood  taken  from  the  arm  of  consumptive 
persons  is  peculiar  in  its  crassamentum ; it  is  never 
cupped,  and  its  upper  surface  has  a somewhat  greenish, 
semi-transparent,  gelatinous  appearance,  with  yellow 
filaments  here  and  there  interspersed.  This  extraordi- 
nary and  characteristic  state  of  the  blood  has  been  for 
years  noticed  by  the  attentive  apothecary,  so  long  at- 
tached to  the  Infirmary  for  Diseases  of  the  Chest.  It 
is  indicative  of  an  actual  and  inappreciable  change  in 
the  circulatory  fluid.  * When  the  muscular  parts  and 
integuments  about  the  chest  are  greatly  attenuated,  lo- 
cal bleedings  are  best  accomplished  by  leeches,  rather 
than  cupping — the  tediousness  of  the  former  may  be 
obviated  by  picking  them  off  when  they  are  tolerably 
full.  Instead  of  fomenting  the  bites  as  is  customary, 
which  practice  exposes  the  patient  unnecessarily  to  cold, 
I advise  some  lint  or  old  linen  to  be  immediately  ap- 
plied, and  not  removed  for  at  least  half  an  hour ; by  this 
means,  the  blood  absorbed  acts  as  a fomentation  to  en- 
courage a sufficient  effusion. 


TREATMENT  OF  CONSUMPTION.  SZ 

I have  ascertained,  by  auscultative  examination,  that 
when  sanguineous  sputa  make  their  appearance  in  chro- 
nic or  latent  phthisis,  they  not  unfrequently  result  from 
inflammation  of  the  lower  lobe  of  one  or  both  lungs, 
causing  an  unusual  degree  of  congestion  in  parts  re- 
maining unhealed  ; my  advice  is,  therefore,  that  a care- 
ful exploration  of  the  chest  be  made,  both  by  the  ear  and 
percussion,  in  all  cases,  however  unequivocal  be  the 
common  symptoms  of  inflammation  of  the  substance  of 
the  lungs.  When  we  have  fully  satisfied  ourselves  that 
the  spitting  of  blood  is  not  the  result  of  any  primary 
change  in  the  vessels  coasting  tuberculous  excavations 
in  the  summit  of  the  lungs,  but  that  it  is  owing  almost 
wholly  to  some  engorgement,  or  sympathy  with  portions 
of  the  lung  beneath  in  a state  of  actual  inflammation,  it 
will  be  found  that  an  effective  abstraction  of  blood,  to 
the  amount  of  fourteen  or  sixteen  ounces,  will  assist  in 
bringing  the  patient  in  a short  time  to  his  wonted  state 
of  health.  Should  this  be  insufficient,  the  bleeding  may 
be  advantageously  repeated  after  a couple  of  days. 
But  it  must  be  premised  that  any  active  treatment  of  this 
kind  employed  without  discrimination,  particularly  when 
much  tuberculous  disease  is  disseminated  through  the 
lungs,  and  has  formed  numerous  cavities  which  have 
seriously  and  manifestly  impaired  the  general  health, 
would  in  most  cases  be  productive  of  the  greatest  evil, 
and  possibly  soon  give  rise  to  oedema  of  the  lungs,  or 
some  other  watery  effusion  elsewhere.  Few  consump- 
tive cases  terminate  fatally,  without  being  preceded  by 
some  dropsical  state  of  the  lungs.  This  generally  oc- 
curs when  the  feet  and  legs  begin  to  swell,  and  is  a 
period  too  when  leeches  even  are  rarely  admissible. 

I shall  now  close  my  observations  on  bleeding  with 
mentioning  that  blood  drawn  from  the  arm,  in  any  in- 
flammatory affection  of  the  chest  co-existing  with 
phthisis,  appears  with  a cupped  and  buffy  coat,  and  not 
with  the  peculiar  appearance  already  noticed  by  me  as 
attending  the  latter  disease  in  its  unmasked  state.  Not 
unfrequently  the  close  of  existence  in  the  consumptive 
individual,  already  reduced  to  the  lowest  condition  of 
weakness  and  emaciation,  is  preceded  by  some  pneu- 
monic and  pleuritic  affection  which  admits  of  no  perma- 
nent relief  by  blood-letting. 


84  TREATMENT  OF  CONSUMPTION. 

Inhalation. — I am  well  aware  that  many  objections 
may  be  started  to  this  practice  from  prejudice,  or  ineffi- 
cient observation.  Strange  to  say,  the  principle  on 
which  this  mode  of  treatment  operates  beneficially  ap- 
pears to  me  quite  unknown  to  medical  men.  It  is  sup- 
posed, that  the  inspiration  of  medicated  vapours  has  in 
many  instances  proved  useful  by  allaying  cough,  and  by 
producing  some  healthy  and  unexplained  change  in  dis- 
eased parts  of  the  lungs,  as  well  as  on  such  adventitious 
surfaces  as  are  formed  after  the  softening,  or  discharge, 
of  tuberculous  matter : but  the  permanent  advantages 
which  inhaling  is  capable  of  affording  are  for  several 
reasons  unsuspected  by  the  generality  of  practitioners. 
First,  because  the  period  during  which  persons  are  di- 
rected to  inhale  is  generally  too  short  to  produce  either 
a catarrhal  or  an  enlarged  state  of  the  lungs,  one  of 
which  conditions  is  absolutely  necessary  in  order  to  sus- 
pend, or  cure  consumption : and,  secondly,  the  appara- 
tuses employed  lor  this  purpose  are  not  constructed 
scientifically,  so  as  to  facilitate  those  physical  changes 
which  it  is  desirable  the  chest  should  undergo.  Proper 
inhalers  ought  to  be  so  arranged  as  to  offer  some  slight 
impediment  to  free  expiration ; which  can  be  effected  by 
having  the  vessels  which  are  to  contain  the  materials, 
to  be  inhaled  large  enough  to  hold  about  two  quarts 
of  liquid,  and  with  covers  perforated  by  two  apertures  ; 
one  of  very  small  size,  serving  as  an  air-vent,  the  other 
furnished  with  a flexible  or  straight  tube  of  narrow 
diameter,  and  at  least  five  feet  long.  For  the  end  of 
the  tube  destined  to  be  received  between  the  lips,  we 
may  have  mouth-pieces  formed  of  ivory  or  bone,  each 
of  them  having  an  aperture  of  a different  size.  The 
length  of  the  tube  will  save  the  patient’s  countenance 
from  being  heated  by  too  close  an  approximation  to  the 
body  of  the  apparatus,  when  filled  with  warm  water ; 
besides,  it  contributes,  together  with  the  small  air-vent, 
to  retard  the  free  egress  of  air  from  the  lungs,  which  I 
shall  presently  show  constitutes,  in  no  small  degree,  the 
great  virtue  of  inhalation. 

An  extraordinary,  but  most  undeserved  reputation  is 
bestowed  on  various  substances,  mechanically  received 
into  the  lungs  in  a state  of  vapour.  Among  these  I may 
mention  tar,  iodine,  chlorine,  hemlock,  turpentine,  and 


TREATMENT  OF  CONSUMPTION.  85 

many  other  articles  of  a stimulating,  or  sedative  nature. 
I attach  little  or  no  importance  to  any  of  them.  If  be- 
nefit is  derived,  it  is,  in  almost  every  instance,  in  conse- 
quence of  some  such  effects  as  the  following  : — Pulmo- 
nary expansion,  to  a degree  sufficient  to  exert  an  influ- 
ence in  bringing  into  contact  the  surfaces  of  those  early 
cavities  which  are  almost  invariably  formed  in  the 
summit  of  the  lungs ; — pulmonary  catarrh,  or  its  com- 
mon consequence,  a vesicular  emphysema,  in  both  of 
which  the  lungs  acquire  an  unusual  magnitude  ; in  the 
latter  more  especially. 

Neither  perfect  recovery,  nor  indeed  exemption  from 
the  danger  of  relapse  into  a consumptive  state,  is  found 
to  occur,  except  in  very  rare  instances,  unless  the  pul- 
monary organs  become  naturally,  or  artificially,  volu- 
minous ; which  not  infrequently  happens  by  the 
supervention  of  some  catarrhal  state  of  the  larynx, 
trachea,  or  bronchial  tubes.  It  is  a most  fortunate 
circumstance  for  some  affection  of  this  kind  to  occur 
early,  as  it  never  fails  permanently  to  arrest  this  most 
fatal  disorder.  When  the  lower  lobes  of  the  lunors  are 

O 

entirely  free  from  tuberculous  matter,  (which  is  often 
indisputably  the  case  for  a considerable  period,  unless 
there  be  strong  hereditary  predisposition,)  and  though 
there  exist,  at  the  same  time,  cavities  in  the  superior 
part  of  one  or  both  lungs,  clearly  indicated  by  perfect 
pectoriloquism,  there  is  almost  a never- failing  hope  of  re- 
covery to  be  entertained,  provided  an  emphysematous 
sound  can  be  heard.  In  fact,  I never  knew  a consump- 
tive person  who  did  not  lose  all  his  formidable  symptoms 
and  regain  health,  when  an  emphysematous,  or  a semi- 
asthmatic change  had  early  taken  place  ; and,  likewise,  I 
never  knew  an  individual  to  become  consumptive  who 
was  subject  to  chronic  catarrh,  or  to  any  species  of 
asthma.  It  is  from  long  consideration  of  these  facts, 
that  I interfere  but  little  with  any  catarrhal  inflamma- 
tion which  may  show  itself  in  the  midst  of  consumptive 
symptoms,  for  I well  know  that  it  will  gradually  super- 
sede all  these. 

I may  here  remark,  that  cavities  in  the  upper  part  of 
the  chest  are  never  healed,  unless  the  pulmonary  tissue 
be  expanded  in  their  neighbourhood,  or  in  the  other 
lobes  of  the  lungs.  In  such  case,  I have  repeatedly 


86  TREATMENT  OF  CONSUMPTION. 

listened  to  some  bronchial  inflammation  which  has 
fortunelj  taken  place  near  to  those  cysts  which  are 
left  when  tuberculous  matter  has  been  removed  by  ab- 
sorption or  expectoration.  I have  been  truly  gratified 
to  hear  the  well-marked  pectoriloquy  gradually  become 
less  distinct,  till,  together  with  the  constitutional  symp- 
toms of  phthisis,  it  has  been  at  last  entirely  lost,  and 
nothing  has  remained  but  the  dry  rale  of  enlarged  air- 
cells,  slight  catarrh,  and  a little  absence  of  respiratory 
murmur  in  the  place  before  occupied  by  tubercles. 

Should  there  be  catarrh  in  the  superior  bronchial  tubes, 
of  a duration  sufficiently  long  only  to  heal  ulcerations 
and  cure  the  patient,  he  may  be  again  attacked  by  con- 
sumption, months  or  years  afterward,  if  there  be  any 
cause  assisting  to  impair  the  general  health  ; but  never 
can  this  relapse  happen,  if  the  bronchial  tubes  be  sub- 
acutely  inflamed  for  a period  sufficient  to  produce  chro- 
nic dyspnoea,  or  habitual  asthma,  more  or  less  severe. 
Half  of  those  which  are  commonly  regarded  as  cases 
of  catarrhal  asthma  originate  in  consumptive  disease 
whose  progress  has  been  arrested  by  the  supervention 
of  that  affection  ; but  in  which  neither  fresh  crops  of 
tubercles,  nor  hectic  fever,  are  to  be  apprehended.  Any 
individual  indeed  having  asthma,  from  whatever  cause, 
is  as  perfectly  exempt  from  consumption  as  he  who  had 
been  consumptive,  but  has  afterward  had  his  disease 
merged  into  asthma.  In  a word,  it  may  be  confidently 
affirmed,  that  no  asthmatic  person  need  ever  fear  be- 
coming consumptive. 

In  order  to  promote  expansion  of  the  aerial  tissue  of 
the  lungs,  it  is  my  usual  practice,  in  the  absence  of  ca- 
tarrh, and  when  congestion  in  the  chest  and  the  symp- 
toms of  hectic  fever  have  been  diminished  by  small 
general  bleedings,  repeated  at  proper  intervals,  or  by 
the  application  of  leeches  over  the  second  and  third  ribs 
anteriorly,  to  advise  inhalation  as  soon  as  possible. 
There  are  few  cases  of  incipient  consumption  but  what 
will  be  rapidly  improved  by  this  treatment,  steadily 
pursued.  The  disease  being  thus  checked,  the  same 
changes  will  follow  which  are  attendant  on  catarrh.  The 
nodules  of  unripe  tubercles  will  become  innoxious  in 
consequence  of  being  surrounded  by  black  secretion,  or 
what  has  been  call^  black  pulmonary  matter ; and 


TREATMENT  OF  CONSUiMPTION. 


87 


small  cavities,  already  formed,  will  have  their  surfaces 
soon  brought  in  contact,  so  as  to  heal  by  what  surgeons 
term  the  first  intention.  It  is,  we  must  own,  preferable 
to  effect  pulmonary  expansion  by  sure  artificial  means, 
rather  than  to  depend  upon  the  uncertain  production  of 
catarrh.  And  there  is  another  point  gained,  inasmuch 
as  recovery  takes  place  unaccompanied  by  the  cough,  or 
difficulty  of  breathing,  generally  attendant  on  those 
cures  which  nature  herself  now  and  then  accomplishes, 
by  introducing  this  less  fatal,  yet  distressing  complaint. 
Inhaling,  performed  two  or  three  times  daily,  for  half 
an  hour  each  time,  will  in  the  space  of  a few  weeks 
work  a wonderful  change  on  the  chest ; externally  the 
muscles  concerned  in  respiration  will  be  manifestly  en- 
larged, and  the  bony  compages  of  the  chest,  both  before 
and  laterly,  visibly  increased ; while,  at  the  same  time, 
the  natural  respiratory  murmur  will  be  heard  internally 
far  more  distinct  than  ever.  Such  has  been  the  increase 
of  size  which  the  chest,  in  young  persons  especially, 
has  undergone  through  the  exercise  of  inhalation,  that 
I have  known  individuals,  after  inhaling  little  more  than 
a month,  require  their  waistcoats  to  be  let  out.  It  is  in 
fact  incredible  to  one  who  has  never  been  at  the  pains 
to  measure  the  chest,  or  examine  its  shape,  what  an  en- 
largement it  acquires  by  the  simple  action  of  breathing 
for  the  time  above  stated,  backward  and  forward, 
through  a narrrow  tube  of  a few  feet  in  length.  I have 
several  times  found,  on  measurement  of  the  chest,  that 
its  circumference  has  increased,  within  the  first  month 
after  inhaling,  to  the  extent  of  an  inch.  I here  speak 
of  patients  not  arrived  at  adult  age.  Though  I attach 
but  little  virtue  to  the  substances  that  are  inhaled,  still, 
as  we  find  patients  prefer  receiving  into  their  lungs  some- 
thing having  sensible  properties  to  pure  atmospheric  air, 
I recommend  a handful  of  hops,  either,  a little  vinegar,  or 
a table-spoonful  of  spirits  of  turpentine,  to  be  added  to 
the  warm  water  in  the  inhaler.  Every  impediment  to 
the  free  action  of  the  ribs  is  to  be  guarded  against  by 
loosening  whatever,  in  the  way  of  dress,  is  at  all  likely 
to  confine  them  ; and  it  would  be  advisable  too  for  the 
patient,  if  strength  allows,  to  inhale  at  times  in  a stand- 
ing position,  as  the  diaphragm  will  then  descend  more 
easily  and  deeply,  and  of  course  allow  the  lungs  more 
room  to  expand. 


88  TREATMENT  OF  CONSUMPTION. 

There  are  cases  in  which  inhalation  is  contra- 
indicated; for  instance,  in  dilatation,  or  hypertrophy 
of  the  heart,  severe  mucous  catarrh,  general  emphy- 
sema of  the  lungs,  pleuratic  or  pneumonic  inflamma- 
tion, haemoptysis,  or  latent  consumption  of  long  stand- 
ing. 

It  is  to  be  discontinued,  at  least  for  a time,  should 
there  arise  distressing  headache,  or  much  internal  tho- 
racic soreness.  When  it  agrees  well,  it  can  be  safely 
and  most  beneficially  used  for  six  months,  or  even  long- 
er. By  this  time,  besides  a removal  of  every  consump- 
tive symptom,  a permanent  enlargement  of  the  chest 
will  have  taken  place,  proving  a perfect  safeguard 
against  the  recurrence  of  any  future  attack. 

No  permanent  benefit  is  to  be  expected  from  this  re- 
medy, when  the  inferior  lobes  of  the  lungs  contain 
cavities,  or  are  studded  with  tubercles  : yet,  even  in  this 
unfavourable  state,  I have  known  relief  arise,  and  sur- 
prising prolongation  of  life  ensue,  from  its  employment. 
I have  individuals  under  my  care,  at  this  moment,  in 
whom  one  lung  is  almost  useless  from  extensive  tuber- 
culous disease,  and  with  even  well-marked  pectoriloquy 
on  the  top  of  the  opposite  lung ; still,  from  having  the 
rest  of  the  lung  on  this  side  in  a satisfactory  state,  and 
thus  being  partially  susceptible  of  the  influence  of  inha- 
lation, the  progress  of  consumption  has  been  arrested  ; 
and,  in  more  than  one  instance,  the  relief  afforded  by 
inhaling  has  enabled  the  individual  to  attend  to  the 
duties  of  his  calling — of  course,  no  very  onerous  ones. 
Indeed,  I shall  feel  happy  to  introduce  any  of  my 
readers,  who  may  entertain  a desire  to  see  such  remarka- 
ble instances  of  the  virtues  of  inhalation,  to  these  patients 
of  mine. 

I must  direct  especial  attention  to  the  circumstance, 
that  restoration,  by  means  of  inhaling,  is  only  to  be 
looked  for  when  the  cavities  are  confined  to  the  sum- 
mit of  one,  or  of  each  lung.  When  they  extend  into  the 
lower  lobes,  relief,  as  I have  just  shown,  will  often  be 
given,  but  it  would  be  unreasonable  to  expect  perfect 
recovery.  The  experience  of  the  medical  world,  from 
the  days  of  Hippocrates  down  to  our  own  time,  has 
proved,  that  medicine  is  utterly  powerless  over  the  ex- 
cavations formed  in  the  lungs  by  tubercular  phthisis.  It 


TREATMENT  OF  CONSUMPTION. 


89 


cannot  bring  into  contact,  and  unite  the  opposite  surfaces 
of  the  cavities  : it  cannot  enlarge  the  pulmonary  tissue ; 
— mechanical  agency  will.  I have  never  known  inha- 
lation fail,  when  resorted  to  in  the  incipient  stage  of  con- 
sumption ; and  am  firmly  of  opinion,  that  when  pursued 
under  the  eye  of  a skilful  practitioner,  who  knows  how 
to  apply  according  to  circumstances  the  other  inferior 
but  still  accessary  powers  of  art,  it  never  will. 

As  tubercles  are  rarely  formed  in  the  muscles  of 
voluntary  motion,  we  have  hence  reason  to  believe  that 
the  same  additional  exercise  of  the  pulmonary  organs, 
by  more  frequent  expansions  and  contractions,  will  act 
as  a preventive. 

Before  I was  aware  how  materially  the  lungs  can  be 
enlarged  by  simply  respiring  through  a long  tube,  of 
small  diameter,  I was  induced  some  years  ago  to  try 
various  means  for  producing  pulmonary  catarrh,  or  some 
corresponding  affection,  in  the  great  air  passage  vulgarly 
called  the  windpipe  ; knowing  well  what  an  excellent 
agent  such  an  affection  is  for  expanding  the  chest,  re- 
moving speedily  well-marked  symptoms  of  consumption, 
and,  in  a word,  destroving:  altogether  the  tuberculous 
tendency.  For  this  purpose,  as  in  the  heat  of  summer 
and  the  early  part  of  autumn  we  rarely  meet  with  cases 
attended  with  a catarrhal  complaint,  one  of  my  expedi- 
ents was  to  oblige  the  patient  to  breathe  twice  or  thrice 
a day  atmospheric  air,  made  cold  by  artificial  means.  In 
more  than  one  case  I succeeded  in  producing  a catarrh, 
which  led  to  the  recovery  of  the  consumptive  patient.  I 
have,  on  several  occasions,  dismissed  those  in-patients  of 
the  Infirmary  for  Diseases  of  the  Chest, — the  wards  of 
which  are  heated  in  winter  so  as  to  imitate  a moderate 
summer  temperature, — whose  consumptive  state  seemed 
to  be  but  little  relieved:  but  owing  to  their  going  at  once 
from  the  warm  atmosphere  to  their  own  abodes,  where 
perhaps  some  of  them  were  badly  secured  against  cold, 
or  indeed  owing  perhaps  to  their  imprudent  and 
thoughtless  exposure  to  the  open  air,  they  have  caught  a 
severe  cold  of  a catarrhal  nature  ; and  this,  I can  assure 
the  reader,  has  alone  effected  a cure  in  some  who  have 
had  tuberculous  excavations  of  ancient,  as  well  as  recent 
date.  I subjoin  a case,  in  which  will  be  seen  the  value 

12 


90 


TREATMENT  OF  CONSUMPTION. 


of  a catarrhal  affection  in  removing,  or  affording  perfect 
security  against  consumption. 

Case  7. — A young  man,  a cutler  by  trade,  having  lost 
three  brothers  by  consumption,  came  to  my  house  in  the 
summer  of  1827,  seeking  to  be  relieved  from  symptoms 
similar  to  those  which  he  had  observed  in  them  during 
their  illness.  He  stated  that  the  first  indication  of  his 
complaint  appeared  after  he  had  had  a severe  attack  of 
rheumatism,  which  was  with  difficulty  removed,  and 
which  left  him  much  debilitated.  When  I first  saw^  him, 
he  computed  that  his  cough,  which  was  soon  followed 
by  a discharge  of  blood  from  the  chest,  had  existed  four 
months.  He  stated,  too,  that  he  had  early  placed 
himself  under  medical  advice  ; but  that,  in  spite  of 
various  medicines  administered  for  his  cough,  the  spitting 
of  blood,  periodic  fever,  profuse  perspirations  at  night,, 
and  occasional  diarrhoea,  in  short,  all  the  unfavourable 
symptoms  seemed  daily  to  increase.  The  moment  I 
saw  him,  his  countenance  bespoke  the  nature  of  his 
malady  ; and  a few  questions  put  to  him  soon  confirmed 
my  supposition,  that  he  had  all  the  common  symptoms 
of  consumption.  On  exploration  of  the  chest  by  the 
naked  ear,  and  by  the  stethoscope^  I ascertained  the 
existence  of  a cavity  in  the  summit  of  the  right  lungy 
which  afforded,  when  he  spoke,  a perfect  pectoriloquy, 
and  there  was  a gurgling  when  he  coughed.  The 
respiratory  sound  was  indistinct  on  the  left  side,- 
anteriorly,  beneath  the  clavicle  and  over  the  second 
and  third  ribs  : in  all  other  parts  the  chest  seemed 
healthy,  save  a state  of  respiration  approaching  the 
puerile,  which  was  heard  in  the  lower  lobes.  In  order 
to  subdue  the  constitutional  fever  and  painful  cough,  I 
directed  some  blood  to  be  taken  from  the  arm  ; and  this 
not  affording  the  expected  relief,  several  leeches  were 
applied  a few  hours  after  to  the  anterior  and  upper  part 
of  the  chest ; and  scruple  doses  of  nitre,  with  a quarter 
of  a grain  of  tartar  emetic,  and  a drachm  and  a half 
of  syrup  of  poppies  were  taken  in  an  ounce  of  some 
demulcent  vehicle,  at  intervals  of  four  or  six  hours 
during  the  day.  This  compound  acted  freely  on  the 
kidneys,  and,  together  with  pills  taken  at  bed-time, 
containing  extract  of  lettuce,  ipecacuanha,  and  precipi-- 
tated  sulphuret  of  antimony,  gave,  in  the  course  of  four 


TREATMENT  OF  CONSUMPTION.  91 

or  five  days,  great  relief  to  his  pectoral  disorder.  Though 
I succeeded  two  or  three  times,  by  means  of  leeches 
again  and  again  applied,  and  medicine  varied  to  meet 
new  symptoms  as  they  appeared,  in  regaining  for  him 
what,  comparatively  speaking,  he  considered  a return 
of  tolerable  health  ; still,  with  a view  to  effect  a perfect 
cure,  it  occurred  to  me,  that  as  my  patient  w^as  a man 
of  no  small  ingenuity,  I might  possibly  get  him  to  make 
a steel  instrument  shaped  like  a collar,  deep  behind, 
and  so  contrived,  while  it  produced  no  inconvenience 
on  the  neck  laterally,  as  to  make  a gentle  pressure  on 
the  small  part  of  the  trachea,  immediately  above  the 
sternum,  and  betw^een  the  sterno-cleido  mastoid  muscles. 
This  new  agent  w^as  soon  ready  for  use,  and  was  worn 
at  intervals  for  the  space  of  tw^o  months.  In  front,  a 
small  piece  of  dry  sponge  was  placed  between  the 
converging  points  of  this  imperfect  collar  and  the  wind- 
pipe ; most  happily  for  the  patient,  the  pressure  on  the  ^ 
wind-pipe  caused  a slight  mucous  inflammation  wdthin 
it,  and  this  was  succeeded  throughout  the  lungs  by 
bronchial  irritation,  with  a slight  wheezing  denoting  an 
enlargement  of  the  air  vesicles.  None  of  these  symp- 
toms were  interfered  with  ; and  they  continued  for  some 
months,  after  every  apprehension  of  consumption  was 
removed.  It  was  really  wonderful  how  much  he  increased 
in  flesh,  and  to  what  bodily  vigour  he  arrived,  especially 
when  the  catarrhal  complaint  had  established  itself  in 
the  neighbourhood  of  the  tuberculous  disease  in  the 
superior  lobes.  At  the  expiration  of  a fortnight  from 
this  time  a loud  mucous  rattle  began  to  appear  near 
to  the  seat  of  the  pectoriloquy  in  the  top  of  the  right 
lung;  all  trace  of  a cavity  was  nearly  lost,  and  the 
respiration  there  became  daily  more  audible.  The 
same  improvement  took  place  in  the  respiration  of  the 
upper  portion  of  the  other  lung,  which,  I have  already 
mentioned,  seemed  to  be  diseased.  With  the  exception 
of  periodic  shortness  of  breathing,  sometimes  preceding 
and  at  other  times  following  fits  of  coughing,  the  patient 
might  be  said,  were  he  judged  only  from  his  looks  and 
his  feelings,  to  be  perfectly  well.  After  tracheal  rattle 
had  been  distinctly  heard  in  the  larynx  for  a month,  and 
appeared  to  be  extending  itself  along  the  trachea  to  the 
larger  bronchial  tubes,  he  was  directed  to  discontinue 


92  TREATMENT  OF  CONSUMPTION. 

altogether  the  further  use  of  that  simple  apparatus,  the 
steel  collar.  On  one  occasion  only  was  it  necessary  to 
moderate,  by  the  application  of  leeches,  the  mucous 
excitement  of  the  lunj^s,  when  it  ran  so  hiorh  as  to  cause 
suffocative  breathing,  incessant  cough,  superabundant 
expectoration,  and  general  febrile  disorder.  With  the 
exception  of  five  grains  of  compound  ipecacuanha 
powder,  and  double  that  quantity  of  extract  of  hops, 
made  into  pills  to  be  taken  at  bed-time,  and  the  occasional 
use  of  a mild  aperient,  there  was  little  else  done  for  the 
supervening  catarrh  ; for  I felt  exceedingly  reluctant  to 
interfere  much,  well  knowing  the  value  of  the  new 
disorder,  and  that  it  would  long  prove  a successful 
antagonist  to  any  future  as  well  as  present  liability  of 
sinking  under  consumption.  In  the  month  of  August, 
1830,  which  was  three  years  from  the  time  he  became 
my  patient,  I had  an  opportunity  of  seeing  him  in  the 
enjoyment  of  excellent  health ; if  I except  a little  asth- 
matic respiration,  which  I detected  by  the  naked  ear, 
whenever  he  made  a forcible  expiration.  The  expira- 
tions were  of  an  emphysematous  character,  in  the  upper 
part  of  the  chest,  both  before  and  behind ; the  air,  in 
fact,  was  heard  escaping  from  the  enlarged  air  cells  with 
a prolonged  murmur  in  which'  dry  cracklings  were 
audible,  perhaps  arising  from  some  air  cells  being  united 
into  one.  Having  ascertained  what  I have  just  described, 
and  how  much  the  shape  of  the  chest  had  been  altered, 
which,  from  being  narrow  in  its  antero-posterior  diameter 
and  flat,  was  become  cylindrical  and  enlarged,  I assured 
him  that  he  never  would  relapse  into  his  former  con- 
sumptive state  ; and  that  with  some  care  bn  his  part, 
in  attending  to  the  directions  which  I gave  him,  his 
present  asthmatic  symptoms  would  have  little  effect  in 
abbreviating  the  duration  of  his  life. 

This  case  is  highly  instructive.  It  is  one  by  which 
mechanical  aid  produced  in  the  midst  of  summer  such  a 
degree  of  general  catarrhal  affection  of  the  air  passages 
of  the  lungs,  that  complete  recovery  took  place.  Nor 
was  this  all ; for,  through  the  emphysematous  state  of 
the  lungs,  a perfect  security  existed  against  any  liability 
hereafter  to  tuberculous  productions.  In  a word,  he 
escaped  all  danger  of  pulmonary  consumption. 

It  may  not  be  uninteresting  to  mention  the  particular 


TREATMENT  OF  CONSUMPTION.  93 

circumstance  which  led  me  to  imagine  and  adopt  the 
above  invention.  A gentleman  of  the  name  of  Willis, 
who  a few  years  ago  resided  in  the  neighbourhood  of 
Kennington,  and  was  under  my  care,  happened  to  have 
a small  oblong  tumour  in  front  of  the  neck,  with  its  in- 
ferior portion  lying  between  the  sternum  and  the  trachea, 
from  which  resulted  a slight  obstruction  to  his  respira- 
tion. This  tumour,  which  had  existed  for  some  years, 
had  induced  a perfectly  asthmatic  state.  By  preventing 
free  expiration,  and  likewise  by  exciting  a slight  contin- 
uous inflammation  of  the  mucous  membrane  from  the 
point  of  pressure  into  the  numerous  ramifications  of  the 
bronchi,  the  air  had  become  imprisoned  within  the  air 
cells,  and  in  this  manner  was  produced  a general  em- 
physematous state  of  the  lungs.  Besides  the  difficulty 
of  breathing,  usually  attendant  on  this  condition  of  the 
pulmonary  organs,  the  obstruction  from  the  tumour  na- 
turally caused  him  to  breathe  with  a loud,  wheezing, 
and  somewhat  croupy  sound.  Observing  this,  I con- 
cluded that  if  a slight  mechanical  resistance  to  the  free 
egress  of  air  from  the  lungs  could  be  produced,  so  as  to 
impart  the  prophylactic  benefits  of  the  asthmatic  state, 
without  the  distressing  and  aggravated  accompaniments 
noticed  in  the  case  just  described,  it  would  be  a reme- 
dial agent  of  no  small  efficacy.  “ On  this  hint  I spake 
and,  seconded  by  the  ingenious  contrivance  of  the  arti- 
zan  whose  case  I have  particularized,  I was  fortunate 
enouorh  to  bring-  the  contrivance  to  bear,  and  to  find  that 
I had  not  miscalculated  its  advantages.  I have  entered 
into  this  detail,  as  it  serves,  by  analogy,  to  throw  addi- 
tional light  on  the  position  I have  advanced  respecting 
the  non-liability  of  the  asthmatic  or  catarrhal  patient 
to  phthisis  although,  from  the  superior  benefits  to  be 

* Circumstances,  in  two  instances,  corroborative  of  the  above  change 
from  a consumptive  to  an  asthmatic  state,  have  occurred  within  my 

own  observation.  Major of  the  U.  S.  armv,  called  on  me  a few 

months  since,  to  obtain  information  respecting  Dr.  Ram.adge’s  views, 
&c.,  and  to  ascertain  whether  the  tube  would  be  advisable  in  his  case; 
he  stated  that  he  had  been  sent  home  three  different  times  to  die,  sup- 
posing he  was  in  the  last  stage  of  consumption,  but  that  he  again  re- 
vived.  Being  in  some  doubt,  from  his  symptoms,  as  to  the  nature  of  his 
disease,  although  he  was  a spare-made  man,  and  much  reduced  in  flesh, 
with  a cough,  difficulty  of  breathing,  &;c.,  I advised  him  to  go  to  Dr. 

W , of  this  city,  and  ascertain  the  nature  of  his  disease — he  did 

so,  and  returned  to  inform  me  that  the  doctor  stated  that  his  disease  had 


94 


TREATMENT  OF  CONSUMPTION. 


obtained  by  a duly  extended  course  of  inhalation,  and 
having  satisfied  my  curiosity  by  the  experiment,  I have  ne- 
ver since  employed  the  preceding  mechanical  contrivance. 

Havincj  noticed  the  effects  arising  from  a small  tumour 
on  the  neck  of  my  patient,  Mr.  Willis,  I may  observe, 
that  that  enlargement  of  the  thyroid  gland  technically 
called  bronchocele,  but  more  familiarly  known  by  the 
name  of  Derbyshire  neck,  induces,  when  considerable, 
similar  symptoms  and  results  by  the  pressure  it  occasions 
on  the  trachea.  Nor  are  the  consequences  of  aggrava- 
ted hysteria  to  be  overlooked  in  this  place  ; since  a fre- 
quent communication  of  spasm  to  the  posterior  membrane 
of  the  trachea,  will,  by  imparting  to  the  person  so  affect- 
ed a slight  asthmatic  tendency,  and  thus  enlarging  the 
volume  of  the  lungs,  preserve  the  female  from  all  lia- 
bility to  pulmonary  consumption. 

A positive  proof  of  the  advantage  accruing  to  the  con- 
sumptive patient  through  mechanical  development  of 
the  lungs,  is  to  be  inferred  from  the  general  immunity 
from  phthisis  enjoyed  by  those  families  in  which  a well- 
formed  chest  is  common  to  all  the  members.  I may 
cite  as,  what  the  lawyers  call,  a case  in  point,  the  nu- 
merous offspring  of  the  venerable  George  the  Third, 
himself  the  model  of  a manly  form.  Heaven  knows, 
nature  must  have  done  more  for  them  than  medicine. 

A negative  proof  of  the  benefits  of  inhalation,  and  a 
positive  one  of  the  inefiicacy  of  medicine,  has  unfortu- 
nately occurred,  of  late  years,  in  the  family  of  a noble 
lord,  to  whose  illustrious  kinsman  this  country  is  indebted 
for  one  of  the  greatest  boons  ever  conferred  upon  it  by 

been  originally  tubercular  consumption,  but  that  it  was  changed  to  an 
asthmatic  state,  and  advised  him  to  dispense  with  the  use  of  the  tube. 
Dr.  W subsequently  informed  me  that  the  above  instance  con- 

firmed him  in  the  correctness  of  Dr.  Ramadge’s  principles,  that  con- 
sumption was  arrested  by  a change  of  the  nature  of  the  disease  in  the 

lungs.  The  other  instance  is  that  of  a Miss  B , since  deceased, 

who  came  to  me  from with  an  introductory  line  from  the  Rev. 

Mr.  Abbot : her  case  was  one  of  so  difficult  a nature,  her  symptoms 

being  so  complicated,  that  I directed  her  to  Dr.  W , to  ascertain 

the  nature  of  her  disease.  Her  whole  appearance  denoted  ponsumption, 
yet  she  had  lingered  so  long  with  cough,  difficulty  of  breathing,  &c., 
that  it  was  a matter  of  astonishment  that  she  did  not  die.  She  re- 
turned to  inform  me  that  her  disease  was  asthmatic.  From  the  account 
she  gave  of  the  former  state  of  her  health  and  symptoms,  there  was 
no  doubt  left  in  my  mind  that  she  would  have  died  years  ago  but  for 
the  intervention  of  asthma.  J.  M.  H. 


TREATMENT  OF  CONSUMPTION. 


95 


legislation.  It  is  impossible  to  look  upon  the  frank,  artless, 
but  pensive  features  of  the  lovely  boy  whose  lineaments 
are  recorded  by  the  imperishable  pencil  of  Lawrence, 
and  not  to  regret  that  medicine  could  elfect  nothing. 

How  lonof  will  it  be  before  this  truth  will  lead  the 
scientific  to  adopt  its  fellow-truth, — that,  so  surely  as 
medicine  alone  will  ever  fail,  the  mechanical  means  I 
have  pointed  out  will  succeed  ? 

While  preparing  this  edition  for  the  press,  I have 
met  with  two  very  singular  cases,  confirmatory  of  my 
view's  ; the  one  in  Hippocrates,  and  the  other  in  a curious 
treatise,  entitled  “ Phthisiologia,”  written  by  Dr.  Rich- 
ard Morton,  a man  of  considerable  eminence  in  our  early 
English  medical  school.  I term  them  singular,  inas- 
much as  written  at  two  such  distant  periods,  they  present 
accounts  which  elucidate  and  strengthen  my  opinions 
as  strongly  as  any  case  taken  from  my  own  memoranda. 
The  father  of  medicine  relates  that  the  daughter  of 
Agasias,  when  a girl,  laboured  under  tubercular  con- 
sumption ; that,  becoming  pregnant  after  marriage,  she 
expectorated  an  unusual  quantity  of  puriform  matter ; 
and  that,  subsequently  to  this,  she  became  asthmatic. 
Here  the  process  of  cure,  as  laid  down  by  me  in  the 
preceding  pages,  is  distinctly  traced.  I have  already 
noticed  the  advantages  of  pregnancy  in  consumption  ; 
and  have  proved,  what  the  above  early  record  so  sur- 
prisingly confirms,  that  if  asthma  supervene  on  con- 
sumption, the  latter  is  cured. 

The  case  I am  now  about  to  quote  bears  witness  to 
the  solidity  of  my  practice  no  less  triumphantly  than 
the  former.  I quote  Dr.  Morton’s  own  words  : — ‘‘  My 
only  son,  before  he  was  eight  years  old,  while  I was  out 
of  town,  was  taken  with  a most  severe  bloody  flux,  by 
which  he  seemed  to  be  brought  into  a consumption,  even 
to  a marasmus,  before  I returned  : but  after  the  bloody 
flux  was  plainly  overcome  by  the  diligent  use  of  all  sorts 
of  convenient  remedies,  and  his  body,  with  respect  to 
his  stools,  was  reduced  to  its  natural  state,  there  still 
remained  a hectical  heat,  a dryness  of  his  skin,  a quick 
pulse,  with  other  signs  of  a hectical  heat.  Moreover, 
his  appetite  failed  him  very  much ; a dry  cough  came 
upon  him,  and  a thickness  of  hearing,  with  a dulness 
of  his  brain  : but  yet  with  the  choice  of  a wdiolesome 


96 


TREATMENT  OF  CONSUMPTION. 


air,  the  use  of  a milk  diet,  and  afterward  of  the  Peru" 
vian  bark,  and  of  a plentiful  nourishment,  which  afforded 
a good  juice,  he  recovered  a good  colour,  and  his  flesh, 
within  the  space  of  three  or  four  months,  without  any 
other  inconvenience,  but  only  that  he  has  been  ever  since 
very  subject  to  an  asthmatical  cough  upon  the  least  occasion'’’ 

My  remaining  observations  on  the  treatment  of  con- 
sumption will  be  brief,  for  two  reasons,  first,  since  I have 
fully  detailed  the  two  most  important  branches  of  the  cu- 
rative process ; and,  secondly,  because  the  general  uses  of 
medicine  are  to  palliate,  or,  by  inducing  a chronic  state, 
to  favour  the  supervention  of  catarrh.  Again,  by  remov- 
ing the  constitutional  symptoms,  the  local  affection  may 
terminate  in  an  insensible  excavation,  hardly  interfering 
with  the  general  health. 

Among  the  innumerable  medicaments  that  have  been^ 
and  are  still  tried,  I shall  specify  a few,  the  advantages 
of  which  are  capable  of  proof,  not  depending  on  the 
caprice  of  fashion — there  being  a fashion  even  in  me- 
dicine— or  upon  any  imaginary  virtues.  Our  dispen- 
satories are  full  of  such  drugs,  and  so  unfortunately  is 
practice  ; yet  the  number  applicable  under  any  form  to 
phthisis,  is  of  a limited  extent. 

Cathartics. — Recourse  must  be  had  to  purgatives 
very  sparingly,  in  the  commencement  of  consumptive 
symptoms,  as  the  general  health  is  usually  deranged. 
From  an  erroneous  view  of  the  causes  of  consumption, 
great  mischief  has  arisen  in  the  employment  of  aperi- 
ent medicines  ; and  this  injudicious  treatment  has  been 
propagated  by  the  sanction  of  names  of  no  mean 
authority.  Instead  of  increasing  debility  by  the  exhibi- 
tion of  cathartics,  it  is  infinitely  preferable  to  remove 
congestion  by  the  moderate  abstraction  of  blood,  as  pre- 
viously noticed.  Great  caution  should  be  observed,  as 
to  the  kind  of  medicine  employed  for  purgative  purposes. 
Saline  aperients  ought  in  general  to  be  avoided,  from 
the  debility  they  induce  by  carrying  off  the  serum  of  the 
blood,  and  by  too  rapidly  accelerating  the  passage  of 
the  chyliferous  matter,  before  due  absorption  takes  place. 
It  should  be  borne  in  mind,  that  a relaxed  state  of  the 
bowels  is  a very  frequent  accompaniment  of  consump- 
tion ; and  that  any  undue  administration  of  laxative 
medicines  will,  in  most  cases,  superinduce  abdominal 


TREATMENT  OF  CONSUMPTION.  97 

grlpings  and  diarrhoBa,  events  which  cannot  be  too 
sedulously  guarded  against.  In  the  inflammatory  com- 
plication of  phthisis,  a powder  composed  of  from  ten  to 
fifteen  grains  of  jalap,  combined  with  two  or  three 
grains  of  calomel,  may  be  administered  as  an  auxiliary 
to  venous  depletion.  Indigestion  is  of  no  uncommon 
occurrence  in  consumptive  complaints,  yet,  as  it  usually 
arises  from  vascularity,  and  morbid  sensibility  of  the 
stomach  and  of  the  intestines,  the  most  rational  method 
of  proceeding  is  to  equalize  the  circulation  by  moderate 
venesection.  Occasionally,  a few  leeches,  applied  to 
the  pit  of  the  stomach  will  be  equally  successful  in  re- 
moving dyspepsia.  As  an  ordinary  laxative,  a few 
grains  of  dried  subcarbonate  of  soda,  calcined  magnesia, 
and  rhubarb,  taken  in  some  liquid  vehicle,  will  be  found 
highly  useful. 

Since  I am  on  the  subject  of  dyspepsia,  I cannot  help 
adverting  to  the  strange  tissue  of  absurdities  gravely 
put  forth  by  a Dr.  James  Johnson  in  a treatise  on  Indi- 
gestion. So  far  as  I can  make  out  the  meaning  of  a series 
of  passages,  which  contain  a number  of  scientific  words, 
serving  only  to  show  a remarkable  ignorance  of  morbid 
anatomy,  this  person  seeks  to  establish  a distinction  be- 
tween the  symptoms  of  phthisis,  when  it  “ supervenes  on 
derangement  of  the  liver  and  digestive  organs and 
when  it  commences  originally  in  the  chest.”  What 
he  would  have  his  reader  understand  by  this  word 
‘^originally”  is  somewhat  difficult  to  make  out.  I never 
before  heard  of  pulmonic  affection  commencing  in 
any  other  part  than  the  lungs.  Does  he  wish  to  have 
it  inferred  that  consumption  at  times  originates  in  the 
stomach,  or  the  head,  or  the  feet  ? Again,  it  is  by  no 
means  clear  what  he  intends  to  convey  by  pulmonic 
affection  supervening  on  “derangement  of  the  liver,” 
&c.  If  the  literal  interpretation  of  these  words  be  taken, 
he  states  what  is  by  no  means  the  fact.  Phthisis  super- 
venes on  impaired  general  health,  and  this  may  be 
occasioned  by  dyspeptic  ailments  ; but  to  say  that  it 
supervenes  on  dyspepsia,  is  nonsense.  But  when  he 
begins  to  draw  his  distinctions,  he  sinks  deeper  into 
“ confusion  worse  confounded.”  He  talks  of  phthisis 
advancing  in  consequence  of  “ a previously  tuberculated 
state  of  the  lungs.”  As  Parson  Evans  says,  “ These  be 

18 


98 


TREATMENT  OF  CONSUMPTION. 


phrases  and  tropes,  look  you.”  Advancing  ! — If  phthisis 
be  not  established,  and  too  surely  established,  when  the 
lungs  are  tuberculated,  then  “ there’s  nothing  serious  in 
mortality.”  We  shall  hear  next,  that  when  an  indi- 
vidual has  got  a wooden  leg,  he  is  in  a fair  way  of  losing 
his  fleshy  one.  Perhaps  Doctor  Johnson  makes  use 
here  of  the  figure  Hysteron,  Anglice,  “ putting  the  cart 
before  the  horse.”  He  then,  pursuing  his  nice  dis- 
tinctions, winds  up  his  medical  budget  by  stating  it  as*a 
pathological  fact,  that  “phthisis,  of  the  common  and 
fatal  kind,  will  soon  be  developed” — after  what  ? — “after 
hepatization  of  the  parenchymatous  tissue  of  the  lungs.” 
Better  and  better  still ! In  plain  English,  the  doctor  ex- 
pressly affirms,  that,  instead  of  consumption  inducing 
hepatization — for  this  is  the  natural  order — the  latter^ 
which  every  anatomist  knows  is  the  consequence,  will 
be  the  cause  of  the  former.  The  attempt  to  unravel 
still  further  this  Gordian  knot  of  technical  terms,  which, 
like  Mrs.  Malaprop’s,  are  “ so  ingeniously  misapplied,” 
would  be  waste  of  time : nor  should  I have  thought  it 
worth  while  to  have  taken  this  slight  notice,  but  for 
the  parade  of  superior  knowledge,  the  “ flourish  of  drums 
and  trumpets,”  with  which  this  nautical  surgeon  ushers 
in  his  dicta.  They  may  suit  the  cockpit,  but  not  the 
temple  of  science. 

Another  individual.  Dr.  .W  Philip,  who  has  likewise 
written  on  Indigestion,  with  more,  although  not  much,, 
success,  has  stated  that  the  pulmonic  affection  is  merely 
sympathetic  ; and  again,  that  the  sympathetic  produces 
actual  disease  in  the  lungs,  indicated  by  some  degree  of 
inflammation  in  the  bronchia,  &c.  Now,  had  his  expe- 
rience been  at  all  of  an  extended  nature,  or  his  obser- 
vation been  keenly  applied  to  even  limited  opportunities, 
he  could  hardly,  one  would  imagine,  have  failed  of  per- 
ceiving that  such  a disease  as  dyspeptic  phthisis  does 
not  exist.  Indigestion  is  a very  common  disorder  ; but 
the  dyspeptic  patient  never  becomes  consumptive,  until 
his  general  health  has  been  seriously  impaired  by  the 
derangement  of  the  digestive  functions.  Dyspepsia,  it 
may  be  as  well  for  him  to  know,  often  follows  pulmonic 
affections,  but  is  never  their  proximate  cause.  Were 
Dr.  P.  in  the  habit  of  employing  auscultative  exploration 
of  the  chest,  he  would  discover  that  the  presence  of 


TREATMENT  OF  CONSUMPTION.  99 

blood  in  the  expectoration  is  not,  as  he  seems  to  imagine, 
the  forerunner  of  tubercles  ; but  that,  in  three-fourths 
of  the  cases,  it  arises  from  the  existence  of  cavities  al- 
ready formed  by  the  softening  down  of  tubercles.  As 
to  inflammation  of  the  bronchia  occurring  at  the  time  he 
speaks  of,  if  it  does,  it  is  of  a very  fugacious  description 
indeed. 

The  singular  opportunities  I have  enjoyed  for  observ- 
ing every  variety  of  disease  connected  with  the  chest, 
have  led  me  to  entertain  views  not  a little  at  variance 
with  those  of  this  writer.  Ten  years  ago  I had 
the  opportunity  of  seeing  a hundred  patients,  at  the 
Infirmary  alone,  in  a single  day ; and  since  that  time 
my  field  for  observation  has  been  very  considerable: 
yet  I have  never  found  the  daily  use  of  mercury,  as 
advocated  by  Dr.  P.,  of  advantage,  even  in  a solitary 
instance.  I have  had,  on  the  contrary,  patients  who 
have  been  under  his  care,  and  who  have  derived  no 
benefit  whatever  from  his  undue  estimate  of  the  virtues 
of  this  mineral.  It  is  by  no  means  improbable,  judging 
from  his  opinions  as  expressed  by  himself,  and  from  his 
non-employment  of  auscultation,  that  he  has  been  mis- 
taken in  the  nature  of  those  cases  which  have  yielded 
to  his  treatment ; that  he  has  supposed  them  to  have 
been  connected  with  phthisis,  when  no  such  complication 
had  existed. 

Emetics. — At  one  period  emetics  were  held  in  no 
slight  repute  ; and  much  useless  torture,  or  I should 
rather  say  injurious  pain,  was  the  consequence  to  the 
consumptive  sufferer.  It  has  always  been  a principal 
object  with  me  to  avoid  every  thing  calculated  to  distress 
or  annoy  without  imparting  benefits  equivalent  to  the 
uneasiness  undergone.  That  this  is  not  the  case  with 
the  administration  of  emetics  is  proved  convincingly  by 
the  fact  that  when  vomiting  is  brought  on  in  a natural 
way  by  violent  coughing,  the  patient  experiences  no 
relief  Whatever  faith  medical  men  may  be  inclined  to 
place  in  the  remedial  powers  of  emetics,  I have  none  ; 
although  I candidly  confess,  that  I am  in  the  daily  habit 
of  prescribing  small  doses  of  the  tartarized  antimony, 
and  of  ipecacuanha  ; yet  in  so  minute  a degree  that  they 
are  within  the  limit  of  actual  nausea. 


100  TREATMENT  OF  CONSUMPTION. 

SuDORiFics. — Twenty  or  thirty  years  ago  it  was  the 
general  practice,  in  all  diseases,  to  determine  to  the 
surface  of  the  body  ; and  some  practitioners,  enamoured 
of  the  wisdom  of  their  youthful  days,  still  adhere  to  it. 
Great  injury  undoubtedly  resulted  from  this  indiscri- 
minate course,  and  more  particularly  would  this  be  the 
case  in  phthisical  complaints.  Although  employed  with 
the  view  of  diverting  morbid  action  from  the  lungs  to 
the  surface  of  the  shin,  yet  the  consequence  of  the 
stimulus  thus  imparted  is  not  unfrequently  increase  of 
hectic  fever,  terminating  in  pulmonary  engorgement,  or 
other  visceral  excitement. 

No  relief  indeed  is  afforded  by  sudorifics ; on  the 
contrary,  wdien  perspirations  occur  spontaneously,  they 
are  found  sensibly  to  reduce  the  patient’s  strength.  In 
the  hot  stage  of  hectic  fever,  I endeavour  to  reduce  the 
tenseness  and  aridity  of  the  cuticular  surface,  by  having 
the  hands  and  upper  part  of  the  body  sponged  with 
tepid  water  and  vinegar ; and  I order  this  to  be  continued 
until  a reduction  of  temperature  takes  place.  The  same 
treatment  is  to  be  pursued  on  every  return  of  the  hectic 
paroxysm.  It  being  of  infinite  importance  to  preserve 
an  equable  temperature  of  the  body,  I uniformly  attempt 
the  removal  of  whatever  state  is  unduly  predominant : 
therefore,  in  the  cold  stage,  I direct  the  immersion  of 
the  feet  in  warm  water,  and  advise  the  patient  to  take 
some  warm  beverage,  as  tea,  &c. ; and  when  perspiration 
is  profuse,  I lessen  it  by  administering  either  an  infusion 
of  columba  or  of  camomile,  in  preference  to  the  acidu- 
lated infusion  of  roses,  in  such  general,  but,  in  my 
opinion,  injudicious  use.  Except  in  the  very  last  stage 
of  the  disease,  the  application  of  leeches  to  the  chest, 
in  periodically  recurring  perspiration,  will  be  found  far 
superior  to  any  tonic  whatever. 

Expectorants. — The  use  of  this  class  of  medicines 
seems  founded  on  no  valid  reasons  ; nor  are  the  benefits 
produced  very  visible  or  satisfactory.  Could  they  stimu- 
late the  mucous  'membrane  of  the  lungs  to  a catarrhal 
state,  they  would  be  beneficial  indeed  : colchicum,  I 
have  reason  to  believe,  occasionally  operates  in  this 
manner  : but  its  effects  are  uncertain. 

In  many  consumptive  cases  there  exists  a superabund- 
ance of  expectoration ; and,  consequently,  in  these  all 


TREATMENT  OF  CONSUMPTION.  101 

f 

expectorants  are  supererogatory.  Above  all,  that  anxie- 
ty which  is  frequently  displayed  to  avert,  or  palliate 
cough,  is  unnecessary,  since  it  often  occurs  that  to  this 
an  emphysematous  state  of  the  lungs  is  owing  ; which 
protective  is  thus  lost,  by  the  injudicious  attempt  to  allay 
the  cough.  The  chief  good  resulting  from  expectorants 
is  not  owing  to  any  specific  action  exerted,  in  particular, 
on  the  pulmonary  organs  : but  rather,  as  is  the  case 
with  ipecacuanha  and  tartar  emetic,  it  is  due  to  a variety 
of  influences.  Thus  the  former  of  these  medicines 
seems  to  act  as  an  astringent  where  expectoration  is 
superabundant ; and,  generally  speaking,  both  these 
substances,  in  addition  to  their  value  as  expectorants, 
aid  all  the  secretions.  Other  expectorants,  as  squill, 
ammoniacum,  myrrh,  &c.,  are  to  be  cautiously  employed 
when  phthisis  is  accompanied  by  hectic  fever;  but  ipe- 
cacuanha, and  preparations  of  antimony,  possess  the  great 
advantage  of  being  of  safe  administration  during  every 
stage.  Mercurial  agents  exert  a powerful  influence  in 
promoting  expectoration,  as  they  likewise  do  on  every 
other  secretion ; and  this  property  has  led  to  most 
injurious  consequences.  Some  years  ago,  I had  oppor- 
tunities of  seeing,  in  the  practice  of  a deceased  physician 
at  the  London  Hospital,  a woful  example  of  the  evils 
arising  from  the  exhibition  of  mercury  in  cases  of  phthisis. 
The  facility  given  to  expectoration  seemed  to  delight  this 
practitioner ; but  it  was  so  rapidly  increased,  and  accom- 
panied by  such  extreme  perspirations,  wasting  away, 
and  diarrhoea,  that  the  patients  soon  went  into  what  is 
vulgarly,  but  not  inappropriately  denominated — gallop- 
ing consumption. 

Narcotics  and  Demulcents. — The  latter,  as  reme- 
dies, are  out  of  the  question ; but,  as  palliatives,  are 
highly  serviceable.  Being  mostly  of  a nutritious  nature, 
they  tend  to  keep  up  the  patient’s  strength,  wLile  they 
soothe  the  irritability  of  the  chest.  The  former  are 
occasionally  useful,  but  they  are  liable  to  great  abuse. 
Given  wdth  a view  to  promote  sleep  at  night,  much  nicety 
is  required  in  their  regulation.  When  the  hectic  state 
and  excitement  obstructive  of  sleep  have  been  removed, 
recourse  may  for  one  night  be  had  to  an  opiate  ; but 
should  it  be  repeated  on  the  succeeding  evening,  it  too 
often  happens  that  its  effect  will  be  lost.  Digitalis  and 


102  TREATMENT  OF  CONSUMPTION. 

hvdrocyanic  acid  have  both  been  extolled  as  of  infinite 
efficacy  ; but  they  are  undeserving  of  the  high  reputation 
bestowed  upon  them.  Dr.  Ferriar  imagined,  that  by 
combining  the  former  with  myrrh  and  sulphate  of  iron, 
he  increased  its  utility  in  consumptive  disease  ; yet,  how 
its  union  with  two  stimulants  could  be  productive  of 
benefit,  I do  not  exactly  see.  As  to  hydrocyanic  acid,  I 
concur  with  Iiaennec  in  regarding  it,  although  it  may 
sometimes  relieve  cough  and  dyspnoea,  as  of  far  inferior 
value  to  many  preparations  of  opium.  In  particular 
idi'v^syncrasies,  in  which  opium  under  any  form  is  found 
to  disagree,  the  extract  of  hyoscyamus,  and  the  feebler 
narcotics,  as  extract  of  lettuce  or  hops,  will  singly,  or 
combined,  lull  cough  and  afford  rest.  I should  regard 
it  unfair  were  I not  to  state,  that  Battley’s  Liquor  Opii 
Sedativus  is  the  preparation  I in  general  prefer.  I may 
here  note,  that  the  pharmacopoeia  of  this  country  exhibits 
an  unsatisfactory  catalogue  of  opiates.  It  is  to  be  hoped 
that  these,  with  other  omissions,  will  shortly  be  rectified. 
The  expected  admission  of  the  numerous  and  intelligent 
physicians  termed  licentiates,  to  the  privileges  due  to 
their  learning  and  science,  will  indisputably  operate  a 
most  beneficial  change  and  form  a new  era  in  medicine. 

Astringents  and  Tonics. — The  first  of  these  are 
employed  for  a threefold  purpose — to  check  discharges 
of  blood  from  the  lungs,  to  restrain  colliquative  perspi- 
rations, and  also  diarrhoea.  Sulphuric  acid,  with  infusion 
of  roses,  has  acquired  much  notoriety  as  an  astringent ; 
but  I seldom  employ  it,  since  I find  its  use  not  unfre- 
quently  followed  by  distressing  tension  of  the  chest. 
Although,  I own,  it  may  be  advantageous  for  a time,  yet 
its  continuance  is  apt  to  exercise  an  effect  the  reverse 
of  what  is  intended.  It  seems  to  me  in  such  cases  to 
increase  rather  than  diminish  haemoptysis.  The  acetate 
of  lead  in  small  doses,  combined  with  opium,  is  far 
superior  not  only  to  the  acid  but  to  every  other  astringent. 
All  danger  of  its  producing  an  unpleasant  action  upon 
the  bowels,  apprehended  by  some,  may  be  obviated  by 
occasionally  intermitting  it,  and  regulating  the  evacua- 
tions. I have  already  pointed  out  the  most  salutary 
mode  of  checking  perspiration,  by  the  application  of 
leeches  to  the  chest,  and  it  remains  for  me  to  notice  the 
best  remedial  agents  for  diarrhoea.  These  are  chalk, 


TREATMENT  OF  CONSUMPTION. 


103 


kino,  catechu,  pomegranate  bark,  and  Armenian  bole. — 
Chalk,  with  a few  minims  of  Battley’s  ])reparation  of 
opium,  administered  in  barley  water,  gruel,  &c.,  will  be 
found  to  equal  in  efficacy  more  compound  admixtures. 
Of  tonics,  the  simplest  are  the  best.  Bark  I rarely,  or 
ever  prescribe  ; but  under  particular  circumstances  in- 
fusion of  columba,  of  camomile,  or  occasionally  of  cas- 
carilla,  may  for  a short  period  be  not  disadvantageously 
employed.  While  the  Brunonian  theory  was  held  as  the 
guide  of  practice,  preparations  of  iron  were  in  high  re- 
pute : and  one  of  these,  the  antihectic  mixture  of  Dr. 
Griffith,  so  termed  it  would  seem  like  “ lucus  o.  non  lu- 
cendo^'  from  its  possessing  properties  the  reverse  of  its 
name,  is  still,  I am  sorry  to  say,  in  estimation  with  some 
practitioners.  The  use  of  such  medicines,  in  a com- 
plaint that  calls  for  every  effort  to  abate  and  moderate 
excitement,  cannot  be  too  highly  reprobated. 

It  is  not  a little  curious,  that  the  only  medical  work 
which  has  I believe,  issued  from  the  University  of  Oxford 
for  the  last  century  and  a half,  should  have  been  wTitten 
to  divulge  the  virtues  of  an  insignificant  astringent.  Dr. 
Bourne,  the  Aldrichian  Professor  of  the  Practice  of  Phy- 
sic, published  in  the  year  1805  an  octavo  volume,  wholly 
dedicated  to  the  recommendation  of  the  uva  iirsi,  or 
whortleberry,  as  a specific  in  phthisis  pulmonalis.  The 
poor  gentleman  even  apologizes  in  his  preface  for  having 
delayed  divulging  this  astounding  discovery  to  the  world 
so  soon  as  he  might  have  done.  I honour  his  sense  of 
humanity,  but  cannot  help  being  amused  at  the  simpli- 
city of  the  professor.  The  little  good  he  did  effect  was 
obviously  due  to  the  medicines  combined  with  the  afore- 
said whortleberry.  As  for  any  pathological  views,  they 
were  out  of  the  question.  He  does  not  even  enter  into 
any  consistent  rationale  of  his  own  practice.  However, 
he  did  manage  to  write  a book,  and.  attempt  in  his  small 
way  to  promote  science : which  is  more  than  many  of 
his  brother  professors  have  done.  The  medical  w^orld 
should  not  be  severe  upon  them,  seeing  that,  from  their 
situation  as  heads  of  the  art,  they  have  enough  to  do  in 
conferring  degrees,  without  the  additional  trouble  of  ac- 
quiring knowledge.  What  can  be  expected  from  a place 
Avhere  there  is  no  regular  school  of  anatomy  ; and  no 
lectures  on  half  the  useful  branches  of  medical  science  ? 


104  TREATMENT  OF  CONSUMPTION. 

Indeed  professors  in  all  places,  in  this  country,  seem  to 
be  alike ; — witness  the  elder  Duncan’s  anomalous  treatise 
on  the  same  complaint.  Both  appear  to  have  been  ex- 
empt from  the  sin  of  having  ever  opened  a human  body. 
May  the  reign  of  such  teachers  be  quickly  at  an  end ! 
To  think,  too,  of  the  last  having  been  forty  years  a 
medical  lecturer  at  Edinburgh,  and  of  having  written 
fifty  volumes, — such  is  his  own  boast : it  is  to  be  hoped, 
at  least,  that  he  never  published  them. 

Balsams. — I hold  it  totally  unworthy  time  or  paper 
to  waste  many  words  on  this  very  futile  description  of 
medicine,  at  least  as  applied  in  consumptive  cases.  It 
was  supposed  in  the  days  of  Dr.  Morton,  and  of  Van 
Swueten  as  well,  that  balsams  exerted  a vulnerary  power  : 
butto  use  such  medicines  at  present,  or  to  suppose  that  any 
medicine  w'hatever  can  heal  ulcers  of  the  lungs,  betrays  an 
extraordinary  ignorance  of  the  peculiar  nature  of  phthisis. 
There  can  be  no  other  possible  method  of  healing  them 
than  by  bringing  their  surfaces  in  apposition,  since,  unlike 
other  ulcers,  they  never  granulate. 

Blisters. — When  expectoration  is  superabundant, 
or  an  oedematous  state  of  the  lungs  is  supervening,  these 
may  be  applied  with  success ; and  when  abstraction  of 
blood  generally,  as  well  as  locally  fails  in  removing  fixed 
pain  of  the  chest,  I find  them  very  useful.  In  gfeneral, 
however,  they  are  too  indiscriminately  employed  ; since 
their  use  at  an  improper  period  tends  to  bring  on,  and 
accelerate,  the  hot  stages  of  hectic  paroxysms.  Thus 
they  superinduce  a continued  febrile  state,  not  unfre- 
quently  terminating  in  some  variety  of  thoracic  inflam- 
mation. One  fact,  peculiar  to  the  application  of  epis- 
pastics  in  consumptive  cases,  seems  almost  unknown  to 
the  medical  profession.  I have  never  known  a patient 
suffer  from  gangrene  through  their  use,  although  such 
cases  are  of  no  uncommon  occurrence  in  other  disorders. 
How^  little  susceptible  individuals  labouring  under  phthisis 
are  to  mortification,  has  been  noticed  by  that  great  au- 
thority, Laennec  ; he  explicitly  states,  that  even  protract- 
ed confinement  is  inapt  to  produce  gangrenous  eschars, 
and  the  whole  course  of  my  experience  corroborates  his 
assertion. 

Diet. — This  should  ever  be  varied  according  to  the 
digestive  powers  of  the  patient.  Van  Swietenhas  given 


TREATMENT  OF  CONSUMPTION.  105 

a homely,  but  very  sensible,  illustration  of  what  ought 
to  form  the  general  guide  in  all  dietetic  advice.  He 
compares  the  physician,  who  pronounces  such  or  such 
food  to  be  wholesome  without  reference  to  the  state  of 
the  patient,  to  the  sailor  who  shouts  out  that  the  wind 
is  fair  without  considering  to  what  port  the  vessel  is 
bound.  As  a general  rule,  the  system  of  overfeeding, 
or,  to  use  a common  phrase,  of  keeping  up  the  strength 
of  the  consumptive  individual,  cannot  be  too  strongly 
deprecated.  It  is,  indeed,  strange  to  find  any  one  so 
imbecile  as  to  recommend  in  a disease  in  which,  even 
under  the  most  judicious  treatment,  febrile  action  will 
be  of  almost  daily  occurrence,  a course  of  diet  suitable 
only  to  the  healthy  and  vigorous  : yet,  in  the  absence 
of  gastric  irritation,  and  on  the  abatement  of  hectic 
fever,  the  food  may  be  of  a nutritive  and  invigorating  de- 
scription. This  caution,  however,  is  to  be  borne  in  mind, 
that  whatever  is  followed  by  increased  heat  of  body 
should  be  abstained  from.  The  best  index  of  food's 
agreeing  with  a patient,  is  the  absence  after  meals  of 
constitutional  disturbance.  Except  during  the  presence 
of  inflammation  and  of  haemoptysis,  I am  in  the  habit  of 
allowing  the  moderate  use  of  meat  once  a day,  wuth  an  egg 
occasionally  at  breakfast  or  by  way  of  lunch,  according 
to  the  patient’s  fancy  ; nutritive  broths,  taken  lukewarm ; 
(indeed,  except  the  patient  feels  chilly,  whatever  liquid 
is  drunk  should  be  of  very  moderate  temperature  ;)  and, 
as  to  a milk  diet,  so  commonly  ordered,  I reject  it  alto- 
gether. It  excites  expectoration  in  an  unusual  degree, 
without  however  leading  to  a catarrhal  state.  When 
consumption  is  decidedly  manifested,  wine  is  for  the 
most  part  inadmissible.  A small  glass  of  ale  at  dinner 
may  at  times  be  permitted ; and  occasionally  at  night, 
with  the  view  of  inducing  sleep. 

I subjoin  a few  leading  observations  on  the  common' 
articles  of  diet.  To  begin  with  fish,  an  important  item 
in  the  cuisine  of  the  invalid.  It  forms  a moderately  nu- 
tritious food ; and  is  so  far  of  advantageous  use,  that  it 
does  not  stimulate  the  body  and  raise  the  pulse  in  the 
same  degree  as  flesh.  The  chief  considerations  in 
selecting  fish  for  the  patient,  are,  in  the  first  place,  its 
exemption  from  oiliness  and  viscidity  ; in  the  second,  its 
firmness  of  texture ; and,  lastly,  the  colour  of  its  muscle, 

14 


106  TREATMENT  OF  CONSUMPTION. 

which  should  be  a clear  white.  Such  being  the  most 
desirable  qualities,  haddock,  whiting,  sole,  cod,  and  tur- 
bot, all,  in  different  degrees,  answer  to  these  requisites. 
The  whiting  and  haddock  are  the  easiest  of  digestion, — 
the  cod,  perhaps,  the  least  so  of  all.  Salmon  is  too 
heating,  and  too  oily,  to  be  indulged  in. 

As  to  shell- fish,  the  claws  of  crabs,  lobsters,  and  craw- 
fish, are  usually  palatable,  and  agree  well  with  the  pa- 
tient. Nor  are  shrimps  and  prawns  to  be  forbidden:  of 
course,  they  should  not  be  indulged  in  to  any  extent ; 
but,  in  moderation,  they  may  be  safely  eaten.  Indeed, 
I have  often  observed,  that  the  petty  delay  and  trouble 
that  there  is  in  iinshelling  this  tiny  fry  seem  to  excite 
the  salivary  glands,  and,  by  supplying  the  food  in  small 
quantities  and  in  slow  succession,  to  stimulate  the  secre- 
tion of  the  gastric  juice.  In  cases,  too,  of  extreme  de- 
bility, the  preparation  and  process  of  the  repast  serve  to 
interest  and  amuse  a mind  weakened  by  long  indisposi- 
tion. Oysters  I generally  leave  to  the  discretion  of  the 
patient.  If  there  is  any  desire  expressed  for  them,  I 
see  no  reasons  for  their  refusal ; but  I have  observed 
that  patients,  whose  expectoration  is  heavy,  generally 
turn  from  them  with  loathing.  I do  not  deny,  that 
many  of  these  articles  are  commonly  and  justly  consider- 
ed as  indigestible ; but  this  can  only  hold  good  when  they 
are  taken  in  any  quantity.  When  their  use  is  moderated 
by  prudence,  I have  never  found  them  more  liable  to 
disagree  than  the  ordinary  edibles  of  the  table.  I may 
mention,  that  I had  a patient,  a very  frequent  article  of 
whose  food  was  turtle.  He  took  it,  of  course,  dressed 
in  a less  stimulating  manner  than  the  usual  form. 

So  much  does  the  agreement  or  disagreement  of  food 
depend  upon  the  constitution  and  habit,  that,  in  laying 
down  dietetic  rules,  we  must  always  bear  in  mind  the 
old  axiom,  Quid  nocet  alien,  alteri  juvat^  I have 
found  it  a very  ordinary  custom  among  my  poorer  pa- 
tients to  indulge  in  eels,  when  first  permitted  after  illness 
to  take  any  thing  of  a more  solid  nature  than  gruels, 
&c.  Judging,  a 'priori,  one  would  conclude  from  their 
oleaginous  nature,  that  they  would  prove  a most  indi- 
gestible article  of  diet : yet  nothing  can  be  more  com- 
mon than  for  them  to  be  chosen  by  the  lower  orders, 


TREATMENT  OF  CONSUMPTION.  107 

on  these  occasions,  as  a delicacy ; and  nothing  can  be 
more  certain  than  that  they  agree. 

So  long  as  hectic  fever,  or  any  febrile  symptoms  con- 
tinue to  any  extent,  the  living  of  consumptive  individuals 
should  indisputably  be  low  ; but  otherwise  a generous 
diet,  in  the  absence  of  fever,  so  far  from  being  depre- 
cated, may  be  safely  left  to  the  option  of  the  patient. 
Mutton  is  the  lightest,  most  digestible,  and  most  nutri- 
tious meat  for  the  invalid ; and  broiling  one  of  the  most 
advisable  modes  of  cookery : at  the  same  time  that  few 
things  are  more  palatable,  nothing  can  be  more  whole- 
some than  a mutton  chop.  Beef  is  of  a denser  fibre,  re- 
quires a longer  space  to  perfect  its  chymification,  and  is 
consequently  less  easy  of  digestion.  Although  it  is 
equally  as  nutritious  as  mutton  to  the  healthy,  it  can 
harldy  be  pronounced  to  be  so  to  the  invalid,  since  it 
requires  a tone  and  vigour  in  the  digestive  organs  which 
the  latter  seldom  possesses.  Veal  and  pork  are  the 
meats  which  follow  next  in  the  order  of  digestion.  I 
need  scarcely  enter  my  Jveto  against  eating  much  of 
the  fat,  whether  of  mutton  or  any  other  meat ; for  the 
delicate  state  of  the  stomach  in  illness  will,  in  general, 
cause  a repugnance  to  it. 

The  meat  should  always  be  plainly  cooked ; and, 
when  it  does  not  contravene  all  the  laws  of  cookery,  I 
would  say,  let  it  be  roasted  : next  to  this,  broiling  is  the 
most  wholesome  form.  Spallanzani  has  demonstrated 
satisfactorily,  that  meat  should  be  neither  over  nor  under 
done  ; and  since  he  has  established  this  point  by  numer- 
ous well-conducted  experiments,  the  general  order  to  the 
cook,  on  this  head,  should  be  to  observe  the  ''juste  mi- 
lieur  A few  words,  as  to  the  reasons  of  the  preference 
given  to  roasting  over  the  other  modes  of  cookery,  may 
not  be  unacceptable  to  the  patient.  The  loss  in  roast- 
ing arises  from  the  diminution  of  the  fat,  which  is  melted 
out,  and  the  evaporation  of  the  water ; in  boiling,  the 
loss  is  caused  chiefly  by  the  solution  of  the  gelatine  and 
osrnazone ; therefore,  the  nutritious  matter,  as  the  gela- 
tine, is  considerably  lessened  in  boiled  meat,  but  re- 
mains condensed  in  roasted.  Its  superiority  over  broil- 
ing consists  in  its  retaining,  from  its  size — we  are  of 
course  supposing  that  a joint  is  put  down — more  of  the 
juices  of  the  meat.  Broiling,  from  the  quickness  with 


108  TREATMENT  OF  CONSUMPTION. 

which  the  outside  of  the  meat  is  hardened,  suffers  it  to 
retain  a much  greater  portion  of  its  juices  than  boiling 
or  baking ; but  even  the  celerity  with  which  a chop  or 
steak  is  thus  cooked,  cannot  enable  it  to  compete,  in  this 
respect,  with  the  advantage  roasting  possesses  from  the 
size  of  the  portion  usually  submitted  in  this  mode  to 
the  action  of  the  fire.  Baking,  from  its  peculiar  process 
not  only  prevents  the  evaporation  of  the  oils  of  the  meat, 
but  renders  them  additionally  indigestible  by  presenting 
them  in  an  empyreumatic  form.  On  the  whole,  how- 
ever, I prefer  it  to  boiling.  Before  quitting  the  subject 
of  meats,  I may  mention  that  venison  or  hare  will  prove 
a very  nutritious  food  to  those  whose  stomach  is  debili- 
tated. They  are  easily  digested  ; but,  as  they  furnish  a 
quantity  of  highly  stimulating  chyle,  they  must  be  avoid- 
ed by  those  whose  state  of  body  requires  the  absence 
of  all  stimuli. 

As  to  the  bird  kind,  the  wild  are  more  digestible,  but 
at  the  same  time  more  stimulating,  than  the  domes- 
ticated ; and  the  darker  the  colour,  and  the  greater  the 
proportion  of  fibrin,  the  more  stimulant  the  chyle  pro- 
duced. There  is  this  advantage  presented  by  the  bird 
kind,  that  they  all  differ  in  flavour  from  each  other,  and 
are  consequently  well  adapted  to  tempt  the  invalid. 
The  appetite,  in  ill  health,  is  often  in  abeyance — not  so 
much  from  weakness  of  the  digestive  functions  as  from 
the  want  of  a little  management  in  varying  the  food. 
Persuasion  is  no  less  requisite  inleadingthe  animal  than 
in  conciliating  the  rational  powers.  An  argument,  pleas- 
ingly addressed  to  the  palate,  is  often  no  less  conducive  to 
bodily  than — when  directed  to  the  judgment — it  is  to  the 
mental  health.  Nothing  is  to  be  deemed  trivial  which 
can  soothe;  nothing  should  be  neglected  which  may, 
with  due  limitation,  contribute  to  invigorate  the  sufferer. 

Climate. — It  has  been  seen  from  the  preceding  pages 
how  much  I am  at  variance  with  the  common  opinions 
entertained  of  phthisis,  and  to  none  am  I more  diametri- 
cally opposed  than  to  those  which  respect  climate.  So 
far  from  sending  a consumptive  patient  to  the  south  of 
France  or  Italy,  I should,  if  change  be  requisite,  deem 
the  climate  of  St.  Petersburgh  a thousand  times  more 
beneficial.  In  the  latter  case  he  has  a chance  of  con- 
tracting catarrh,  and  of  thus  staying  consumption : in 


TREATMENT  OF  CONSUMPTION.  109 

the  former,  any  catarrhal  state  which  might  exist  would 
assuredly  be  fatally  removed.  When  I hear  of  con- 
sumptive individuals  being  recommended  to  try  the 
genial  climes,  as  they  are  absurdly  termed  in  these  in- 
stances, of  Lisbon,  Madeira,  or  other  sunny  lands  ; and 
when  I reflect  on  the  evidence  given  by  medical  statistics 
of  their  deadly  influence  on  phthisis,  I long  to  suggest 
the  fitting  answer  to  such  advisers, — ''Me  vestigia  terrent 
omnia  adversum  s'pectantia,  7iulla  retrorsura''  My  ex- 
perience on  this  point  is  full  and  explicit ; and  I could 
substantiate  it,  were  it  requisite,  at  the  close  of  a treatise 
the  scope  of  which  has  been  to  prove  the  true  nature  of 
this  little  understood  malady,  by  numerous  cases.  Two, 
however,  which  have  come  to  my  knowledge  since  the 
publication  of  the  last  edition  of  this  work,  are  on 
several  accounts  so  interesting,  that  I am  unwilling  to 
withhold  them.  The  first  of  these,  which  I extract 
from  the  letter  of  an  eminent  solicitor  in  the  west  of 
England,  who  had  occasion  to  consult  me,  bears  ample 
and  irresistible  evidence  to  the  soundness  of  my  conclu- 
sions. It  comes  with  the  full  weight  of  authority,  for  it 
is  a true  tale  told  by  the  most  unexceptionable  witness. 
The  writer  commences  by  stating  that  the  death  of  three 
sisters,  a brother,  and  his  mother,  of  consumption,  had 
naturally  induced  some  anxiety  on  his  part,  and  led  him 
to  consult  me  for  symptoms  it  is  here  unnecessary  to 
detail.  He  then  proceeds  as  follows  : “ I am  unacquaint- 
ed with  medical  science,  but  I presume  that  what  you 
call  ‘ a permanent  catarrh,’  I vulgarly  designate  a con- 
stitutional cough, — if  this  be  so,  my  own  father  affords 
a striking  illustration  of  the  correctness  of  your  views. 
He,  when  young,  was  considered  very  consumptive, 
and  to  use  his  own  words  was  ‘ sent  home  from  abroad 
twice  to  die  among  his  friends,’  the  foreign  doctors  pro- 
nouncing his  case  to  be  incurable  decline.  The  first 
time  he  rallied,  probably  in  consequence  of  the  voyage, 
&c.,  but  relapsed  after  his  return  to  Italy,  where  he  was 
when  first  attacked—^^  further  corroboration  of  your 
opinions.)  Business  then  called  him  to  Newfoundland, 
where  he  was  exposed  to  the  severest  weather.  He 
returned  to  England,  apparently  without  a chance  of 
living  many  weeks  ; he,  however,  soon  exhibited  indi- 
cations of  amendment,  and  although  a strong  cough  and 


110 


TREATMENT  OF  CONSUMPTION. 


expectoration  continued  and  never  left  him  for  sixty 
years,  he  attained  the  age  of  84,  and  never  from  the 
establishment  of  his  catarrh  (if  such  it  was)  knew  a 
day’s  illness  of  consequence,  with  the  exception  of  occa- 
sional attacks  of  the  gout.  There  are  other  circum- 
stances,” the  writer  continues,  “which  I have  not  space 
to  mention.  My  eldest  sister  has  escaped  hitherto,  and 
she  has  a similar  cough,  and  has  had  it  for  years  -^  * * * * * 
the  other  members  of  my  family  who  have  died  in  de- 
cline had  no  such  constitutional  cough.”  The  above  is 
surely,  to  use  the  language  of  Shakspeare,  “confirma- 
tion strong  as  proof  of  holy  writ.”  The  other  case  to 
which  I have  alluded  is  not  equally  valuable  in  point  of 
conclusive  testimony  with  the  preceding,  yet  is  far  from 
foreign  to  the  purpose.  It  is,  indeed,  rather  curious, 
that  as  I had  originally  instanced  the  climate  of  St.  Pe- 
tersburgh  as  preferable  to  more  southern  latitudes, 
selecting  it  by  chance  as  the  representative  of  cold  climes 
in  general,  the  following  should  have  been  sent  me  as  a 
piece  of  gratifying  news  by  a lady  of  high  rank,  a patient 
of  mine  : — “ I have  now  before  me  a confirmation  of  your 
views  of  the  beneficial  effects  of  a cold  climate  in  pul- 
monary cases,  in  a letter  from  Mr.  Canning,  (the  pre- 
mier s son,)  who  has  spent  the  last  winter  in  St.  Peters- 
burgh,  though  many  of  his  friends,  in  consequence  of  his 
extreme  delicacy  and  liability  to  attacks  on  the  chest, 
dreaded  the  effects  of  that  climate,  and  urged  him  to 
visit  the  south  of  Europe  in  preference.  He  says,  ‘ I 
have  never  felt  so  well,  or  been  so  free  from  cough  and 
every  ailment  as  since  I have  been  in  Russia.’” 

The  author  of  the  article  on  “ Climate”  in  the  “ Cyclo- 
paedia of  Practical  Medicine,”  a work  based  on  a foreign 
prototype,  but  far  inferior  in  original  views,  has  obtruded 
some  crude  notions  on  the  subject,  which,  being  calcu- 
lated to  mislead  the  young  practitioner,  I shall  briefly 
notice.  He  writes  as  follows  : — “ The  great  desideratum 
in  this  country  is  to  find  a mild  climate  and  sheltered 
residence  for  our  pulmonary  and  other  delicate  invalids 
during  the  winter  and  spring” — and  then  proceeds  to 
specify  the  various  advantages  of  our  different  watering- 
places.  Now  it  is  lamentable  to  find  in  a work  of  so 
much  pretension,  a writer,  who,  at  this  time  of  day,  is 
so  obtuse  as  to  advocate  opinions  which  have  become 


TREATMENT  OF  CONSUMPTION.  Ill 

the  opprohria  of  the  science.  If,  instead  of  repeating 
platitudes  which  have  been  handed  down  from  father  to 
son,  he  had  taken  the  trouble  to  repair  to  some  of  the 
spots  whose  salubrity  he  vaunts,  and  examiue  the  tomb- 
stones in  their  respective  burying  grounds,  he  would 
have  discovered  from  the  excessive  proportion  of  deaths 
occuringin  the  spring  of  life,  particularly  among  females, 
that  consumption  here,  if  anywhere,  “shadowed  the 
portals  of  the  tomb.'’  As  a friend  once  observed  to  me, 
a walk  in  Clifton  church  yard  read  a finer  homily  on  the 
vanity  of  life  than  any  sermon  which  he  knew.  He 
mentions,  to  prove  the  beneficial  effects  of  the  climate 
of  Madeira,  'that  out  of  fifty-two  patients  who  went 
thither  in  a given  number  of  years,  twenty-three  re- 
covered ; which,  if  it  proves  anything,  v/ould  indisputa- 
bly establish — were  the  cases  accurately  reported — the 
efficacy  of  a sea  voyage,  since  those  who  died  suc- 
cumbed for  the  most  part,  it  would  seem,  from  too  prolong- 
ed a stay  on  the  island.  The  truth  is,  this  person  is  con- 
tented with  writing  in  the  usual  vague  manner  on  the 
efficacy  of  a warm  climate,  without  condescending  to 
explain  how  warmth  can  heal  up  a cavity  in  the  lungs, 
as  if  indeed  there  were  a charm  in  the  phrase — warm 
climate.  I have  had  numerous  patients  who  have  re- 
turned from  these  lands  of  “ the  myrtle  and  vine”  with 
excavations  in  the  pulmonary  organs,  but  never  knew  a 
solitary  instance  in  which  a cure  has  been  the  result, 
except  by  the  fortunate  supervention  of  a catarrh  or 
bronchial  affection.  Facts  are  the  best,  and  most  stub- 
born arguments. 

So  decided  am  I on  this  head,  that  I never  admit  into 
the  infirmary  a phthisical  patient  with  recent  catarrh, 
because  its  wards  are  heated  in  winter  time  so  as  to  re- 
semble a moderate  summer  temperature.  The  cases 
of  consumption  that  come  under  my  notice  in  summer 
are  nearly  double  the  number  of  those  I see  in  winter.  The 
reason  is  evident : — the  augmented  temperature  of  the 
weather  increases  the  intensity  of  two  of  the  most  im- 
portant stages  of  the  hectic  paroxysm — the  hot  and  the 
sweating.  To  subdue  these  then  becomes  peculiarly 
difficult : how  likely  they  are  to  be  aggravated  by  going 
abroad,  any  well-constructed  thermometrical  table  will 
tell.  Again,  if  the  disease  be  latent,  removal  to  a 


112 


TREATMENT  OF  CONSUMPTION. 


warm  climate  is  the  most  probable  means  of  making  the 
case  one  of  manifest  phthisis.  In  uniformity  with  these 
opinions,  I feel  no  anxiety  respecting  consumptive 
patients  being  kept  scrupulously  within  doors.  When- 
ever the  weather  permits,  they  should  be  allowed  to  take 
an  airing  daily;  but  be  by  no  means  suffered  to  remain 
so  long  as  to  be  sensible  of  chillness  or  cold. 

From  every  inquiry  I have  made  with  respect  to  the 
influence  of  climate,  I conceive  that,  all  things  duly  con- 
sidered, the  patient  cannot  have  a more  suitable  residence 
in  winter  than  in  some  of  the  spacious,  well-ventilated 
streets  of  our  own  metropolis.  Another  consideration — 
a great  one  to  the  invalid — is  that  of  comfort,  a word 
indigenous  among  ourselves.  Many  of  those  who  had 
been  led  by  blind  guides  to  roam  abroad  in  a vain  search 
after  that  health  which,  under  judicious  treatment,  they 
might  have  preserved  here,  have  assured  me,  to  use  the 
language  of  Sterne,  that  they  had  done  better  to  “have 
remained  dry  shod  at  home  and  I am  convinced  that 
the  greater  number  thus  sent  on  a useless  errand  make 
— when  hundreds  of  miles  from  their  own  comfortable 
fireside — the  reflection  that  occurred  to  honest  Touch- 
stone ; — “ Ay,  now  am  I in  Arden— the  more  fool  I ; 
when  I was  at  home  I was  in  a better  place.” 


APPENDIX. 


CASE  I. 

SUPPOSED  CONSUMPTION  CURED  BY  PARACENTESIS. 

Exuperius  V.  Parker,  aged  32,  of  the  merchant 
service,  but  formerly  a petty  officer  in  the  royal  navy, 
was  admitted  into  the  Infirmary  for  Diseases  of  the  Chest 
in  November,  1831.  He  was  at  this  time  suffering  under 
frequent  and  painful  cough,  attended  with  expectoration 
of  opaque  yellow  sputa,  singularly  fetid,  and  so  abundant 
in  its  discharge  as  to  amount,  in  the  course  of  the  day, 
to  three  quarts ; it  was  occasionally  tinged  with  blood. 
Along  with  violent  pain  in  the  inferior  part  of  the  left 
side,  his  respiration  was  obstructed  and  difficult ; and 
his  sleep  was  unrefreshing  and  broken  by  constant 
suffering,  and  accessions  of  high  fever  on  the  approach 
of  night.  He  likewise  laboured  under  profuse  perspira- 
tions, was  excessively  emaciated,  and  his  complexion  of 
a sickly  yellow  hue.  It  appeared,  on  inquiring  the 
causes  which  had  led  to  this  state,  that  while  on  his 
passage,  in  1829,  from  Kingston  to  Morant  Bay,  in  Ja- 
maica, he  had  been  frequently  drenched  to  the  skin,  and 
that  he  had  suffered  his  clothes  to  be  dried  on  him  by 
the  heat  of  the  sun.  In  consequence  of  this,  as  he 
supposed,  he  was  seized  with  the  yellow  fever,  and,  on 
a relapse  occurring  after  his  return  to  Kingston,  he  was 
admitted  into  the  hospital.  The  fever  was  so  violent 
as  to  produce  delirium,  during  which  he  repeatedly  rose 
from  his  bed  to  commit  suicide,  and  beino-  then  under  a 
course  of  mercury,  he  concluded  that  he  must,  in  these 
paroxysms,  have  caught  cold ; since,  when  convalescent, 
he  experienced  severe  pains  in  the  left  breast,  accompa- 
nied by  violent  cough.  The  latter  continued  unabated ; 
and  on  his  return  to  England  he  consulted  a medical 
man  at  Limehouse,  after  a violent  seizure,  in  which  he 

15 


114 


APPENDIX, 


experienced  a sense  of  strangulation,  followed  by  a 
copious  discharge  of  matter.  Being  regarded  by  this 
gentleman  as  in  the  last  stage  of  consumption,  he  was 
induced  to  apply  to  the  infirmary.  Here  he  derived 
such  relief,  notwithstanding  the  existence  of  a large 
abscess,  occupying  the  inferior  lobe  of  the  left  lung, 
which  I detected  on  the  first  examination  of  the  chest, 
that  I recommended  him  to  go  to  sea  again.  I was 
induced  to  give  this  advice  from  having  met  with  two  or 
three  similar  cases,  in  which  the  abscess  had  remained 
stationary  for  some  years.  He  again  made  a voyage  to 
the  West  Indies  : on  his  return  from  which  to  this  country 
it  was  that  he  presented  himself  to  me,  affected  with 
the  formidable  symptoms  I have  detailed  at  the  com- 
mencement of  the  case. 

Having  satisfied  myself  by  auscultation  with  the  naked 
ear  (which  I invariably  prefer  to  the  stethoscope)  of  the 
extent  of  the  disease,  and  after  various  topical  applications, 
combined  with  constitutional  treatment,  had  failed  to 
mitigate  the  intense  pain  in  his  side  or  to  relieve  the 
suffocative  respiration,  I determined  to  introduce  a 
small  trochar  into  an  intercostal  space  immediately  over 
the  seat  of  the  abscess.  I had  resolved  to  perform  this 
operation  when  I was  first  called  in  to  this  patient,  two 
years  previous  to  the  period  of  which  I am  now  speak- 
ing, had  no  improvement  taken  place ; but  finding  his 
health  so  amended  on  the  very  day  I had  fixed  for  the 
paracentesis  thoracis,  as  to  preclude  its  necessity,  I 
deemed  it  expedient  to  trust  to  time  and  palliative  treat- 
ment. The  result  proved  I had  not  judged  incorrectly. 
But  to  return  to  the  operation.  Having  observed  a 
slight  tumefaction  about  two  inches  beneath  the  left 
nipple,  I directed  Mr.  Herring,  in  the  presence  of  Mr. 
Hudson,  navy  surgeon,  to  open  it ; having  first  carefully 
ascertained  that  the  pressure  of  the  accumulated  matter 
had  occasioned  a sensible  inclination  of  the  heart  toward 
the  right  side.  From  the  intensely  acute  pain  felt  in 
this  spot  by  the  patient,  for  which  the  abstraction  of 
blood  afforded  no  relief,  it  appeared  to  me  that  nature 
was  on  the  point  of  endeavouring  to  work  a cure  by 
gangrene  of  the  pleura ; and  that  by  fixing  on  this  as 
the  spot  of  election,  a ready  escape  would  be  given  to 
the  contents  of  the  pulmonary  abscess.  After  the  divi- 


APPENDIX. 


115 


sion  of  the  integuments  by  the  lancet,  the  same  instru- 
ment was  used  to  open  the  intercostal  space ; and  no 
sooner  was  this  effected  than  a quantity  of  air  issued 
from  the  orifice  with  a hissing  noise,  followed  by  a 
discharge  of  opaque  yellow  matter  similar  to  his  expec- 
toration, wdth  the  exception  of  its  containing  particles 
of  a friable  substance.  The  opening  thus  made  con- 
tinued to  discharge  matter,  mixed  with  air,  for  the  space 
of  ten  days,  with  surprising  mitigation  of  his  previous 
suffering.  Having  about  this  period  imprudently  sat  for 
a considerable  time  in  an  unaired  apartment,  he  was 
seized  with  so  violent  an  inflammation  of  the  bowels 
as  to  demand  vigorous  and  decided  antiphlogistic  treat- 
ment. This  attack  produced  a sudden  and  entire  sus- 
pension of  the  thoracic  secretion  ; but  on  the  abatement 
of  the  inflammatory  symptoms,  his  convalescence  was 
slowly  though  permanently  effected.  It  should  be 
mentioned,  that  on  examining  his  chest,  I ascertained 
that  the  portion  of  the  lung  which  had  previously  been 
the  seat  of  matter  and  air,  and  from  which  a clear 
gurgling  sound  as  well  as  pectoriloquism  emanated, 
began  almost  immediately  after  the  operation  to  be 
occupied  by  the  dilated  pulmonary  tissue  ; a process 
indicated  by  respiratory  murmur.  Before  the  operation, 
and  indeed  for  three  years  previously,  the  respiration  of 
the  whole  of  the  right  lung,  and  of  the  upper  portion 
of  the  left,  as  far  as  a line  drawn  horizontally  from  the 
outside  of  the  nipple  of  the  left  breast  to  the  spine,  had 
been  distinct  and  somewhat  puerile.  In  the  inferior 
part  of  the  left  side  of  the  chest,  pectoriloquism  was 
clearly  marked ; and  nearly  the  whole  of  the  low^er 
lobe  of  the  left  lung  was,  as  far  as  I could  judge,  the 
seat  of  an  immense  abscess,  from  wdiich  he  could 
discharge  matter  at  will,  even  to  the  amount  of  a tea- 
cup full.  At  times,  during  the  action  of  coughing,  I 
could  perceive  the  intercostal  spaces  over  the  vomica 
apparently  distended.  Mensuration  of  the  chest  gave 
no  perceptible  difference  between  the  capacity  of  the 
two  sides ; but  that  enlargement  of  the  ends  of  the 
fingers,  especially  of  the  thumbs,  which  I have  already 
noticed  as  indicative  of  the  existence  of  large  excavations, 
was  in  this  case  particularly  observable.  On  his  reco- 
very, this  unnatural  tumefaction  entirely  subsided.  I 


116 


APPENDIX. 


have  been  thus  minute  in  detailing  this  case,  from  my 
conviction  of  its  rarity  and  importance.  It  was,  as  has 
been  seen,  a case  of  pulmonary  abscess  which  had  ex- 
isted for  three  years,  resulting  from  the  combined  effects 
of  yellow  fever  and  severe  cold,  and  terminating  in 
pneumonia.  During  the  greater  part  of  this  time  I 
was  called  upon  to  observe,  and  consequently  felt  a 
strong  interest  in  its  progress.  As  I had  early  intimated 
to  my  pupils  my  judgment  on  this  case,  and  was  sanguine 
in  my  belief  of  the  patient’s  recovery,  I derived  great 
satisfaction  from  having  the  precision  of  my  diagnosis 
verified. 


CASE  II. 

CONSUMPTION  CURED  BY  PARACENTESIS. 

David  Scott,  aged  seventeen,  admitted  as  an  in- 
patient of  the  Infirmary,  November,  1827,  had  been  in- 
disposed eleven  years ; his  illness  originated  in  his 
having  taken  arsenic  by  mistake.  For  several  years 
previous  to  my  seeing  him,  he  had  been  afflicted  with 
cough,  and  other  symptoms  of  consumption.  On  enter- 
ing the  infirmary  he  showed  none  of  the  usual  signs  of 
emaciation  in  his  person,  but  there  was  an  unhealthy 
fulness  and  flushing  in  his  face  ; he  expectorated  abun- 
dantly viscid  frothy  sputa,  of  a greenish  colour,  and 
semi-opaque.  This  matter,  amounting  to  about  one 
quart  daily,  was  of  an  odour  so  intolerably  offensive  as 
to  require  the  almost  instant  removal  of  the  vessel  which 
received  it,  in  order  to  spare  the  feelings  of  the  patients 
of  the  same  ward.  Conceiving  that  a well-regulated 
atmosphere,  such  as  that  of  the  Infirmary,  (which  is 
kept  of  a uniform  temperature  by  means  of  German 
stoves,)  would,  conjoined  with  sedatives,  lessen  the  co- 
piousness of  the  discharge,  I deemed  it  advisable  to  try 
their  influence  for  a time.  After  a month’s  sojourn  in 
the  Infirmary,  and  the  failure  of  remedial  agents,  finding 
his  feet  oedematous  and  considerable  dyspnoea  present, 
and  that  there  was,  in  fact,  a decided  change  for  the 
w’orse,  I resolved  to  have  recourse  to  an  operation.  His 
condition,  at  this  period,  was  as  follow^s.  On  the  right 
side  anteriorly,  from  the  clavicle  to  the  fourth  rib,  there 


APPENDIX. 


117 


was  a strong  gurgling  rattle,  indicating  the  passage  of 
air  through  cavities  containing  matter.  The  character 
of  the  sound  induced  the  belief  that  the  fluid  was  in 
immediate  contact  with  the  walls  of  the  chest.  Pecto- 
riloquism  was  well-marked,  posteriorly,  as  well  as  ante- 
riorly ; his  respiration  cavernous,  but  there  was  an  en- 
tire absence  of  the  souffle  voile  (the  veiled  puff.)  Hence 
I became  certain,  that  the  surface  of  the  lung  adhered 
firmly  to  the  costal  pleura.  Percussion  on  the  same 
side,  as  well  as  the  naked  ear,  showed  that  some  portion 
of  the  inferior  lobe  of  the  lung,  a little  below  the  exca- 
vations, still  admitted  the  passage  of  air.  On  the  left 
side  the  chest  sounded  well,  and  the  respiration  was 
distinctly  audible  over  the  whole  of  it,  except  below  the 
clavicle,  where  I at  once  detected  imperfect  pectorilo- 
quism.  The  operation  was  performed  with  a small  tro- 
char,  in  the  presence  of  Mr.  Herring,  the  apothecary, 
and  of  more  than  twenty  of  my  pupils,  by  a surgeon,  a 
fellow-lecturer  of  mine.  The  place  of  election  was  in 
the  intercostal  space,  a little  anterior  to  the  digitations 
of  the  greater  serratus  muscle.  It  was  my  desire  that 
the  puncture  should  have  been  made  between  the  third 
and  fourth  ribs  ; however,  it  so  happened  that  the  instru- 
ment was  introduced  between  the  fourth  and  fifth,  upon 
which  there  immediately  issued  a quantity  of  air,  with  a 
hissing  noise,  without  any  discharge  of  matter.  The 
point  of  the  trochar,  indeed,  exhibited  traces  of  pus,  and 
although  it  had  been  fairly  introduced,  yet  the  place  of 
election  was  too  low  to  suffer  the  escape  of  the  matter. 
Observing  that  the  patient  was  lapsing  into  syncope  du- 
ring the  rushing  out  of  the  air,  I stopped  its  farther 
escape  by  placing  my  finger  over  the  orifice,  until  this 
could  be  properly  secured  by  bandages.  On  his  re- 
covering from  this  disposition  to  faint,  and  scarcely  com- 
plaining of  pain,  I explored  his  chest  with  my  naked 
ear,  and  in  the  region  of  the  spot  operated  upon,  I dis- 
tinguished a dry,  crepitous  rattle,  accompanied  by  a con- 
tinued sound  as  of  a rent,  or  as  of  something  being  torn 
within  the  chest.  This  particular  noise  lasted,  and  even 
increased,  for  some  days.  Subsequent  to  the  operation, 
he  slept  well,  with  the  aid  of  a composing  draught ; his 
expectoration,  as  well  as  the  oedema  of  his  legs,  gradu- 
ally diminished,  and  for  a short  period  he  exhibited 


118 


APPENDIX. 


every  sign  of  returning  health.  However,  confinement 
to  the  house  appearing  to  operate  injuriously,  it  was  re- 
solved he  should  return  to  his  place  of  abode  in  the 
country,  a short  distance  from  town.  Here  I saw  him 
two  or  three  times,  and  at  first  he  displayed  symptoms  of 
amendment;  but  subsequently  his  breathing  became 
troublesome,  in  consequence  of  an  emphysematous  state 
of  his  left  lung,  and  of  the  other’s  being  from  cicatriza- 
tion of  its  several  cavities,  and  from  compression  also, 
impermeable  to  air.  So  great  was  this  compression  pro- 
ceeding from  contraction  of  the  chest,  that  he  became 
what  is  termed  pigeon-breasted.  As  a consequence 
of  the  hepatized  state  of  the  one  lung,  w^hich  occurred 
a few  months  afterward,  the  circulatory  functions  were 
disturbed,  and  venous  congestion  gave  rise  to  general 
dropsy.  I recommended  abstraction  of  blood  to  equal- 
ize the  circulation,  diuretics,  and  other  hydropical  re- 
medies, but  fruitlessly,  he  having  been,  I apprehend, 
prejudiced  against  my  advice  by  some  neighbouring 
practitioner.  After  much  suffering  he  succumbed  to  this 
complication  of  disease,  about  eleven  months  from  the 
time  of  his  leaving  the  Infirmary.  I was  sent  for  to  ex- 
amine the  body,  which  I did  about  twenty-four  hours 
after  decease.  Notwithstanding  the  deformity  which 
the  chest  had  undergone,  there  was  no  perceptible  con- 
traction of  the  affected  side,  which,  subsequent  to  the 
operation,  had  yielded  the  fleshy  sound  on  percussion. 
The  right  lung  was  one-fourth  less  than  the  left,  and  ad- 
hered intimately  to  the  costal  pleura  by  well-organized 
cellular  tissue,  and  likewise  to  the  middle  mediastinum, 
which,  with  the  heart,  was  forced  considerably  into  the 
right  side  of  the  chest,  by  enlargement  of  the  left  lung. 
This  lung  was  altogether  emphysematous,  remained  un- 
collapsed, and  occupied  the  entire  cavity  of  the  left  side 
of  the  chest.  The  anterior  edge  was  rounded,  and  dis- 
played vesicles  wdiich  were  of  great  size,  owing  to  the 
union  of  several  air-cells  into  one.  The  summit  of  the 
lung  adhered  to  the  chest,  developing  in  its  centre  the 
indurated  trace  of  cicatrization ; and  it  presented  several 
nodules  of  tubercles,  surrounded  by  a copious  deposite  of 
black  pulmonary  matter.  In  the  cavity  of  the  pleura, 
there  were  above  two  pints  of  reddish  serosity.  On 
making  a longitudinal  section  of  the  right  lung,  its  inte- 


APPENDIX. 


119 


rior,  which  was  flaccid,  somewhat  fleshy,  and  of  a mar- 
bled blue  and  brown  colour,  presented  cellular  lines 
running  in  different  directions,  being  the  remains  of  ob- 
literated excavations ; but  there  was  not  the  slightest 
vestige  of  tuberculous  formation.  The  pericardium  con- 
tained about  a tea-cup  full  of  serum,  and  the  apex  of  the 
left  ventricle  was  unusually  prolonged  ; a considerable 
quantity  of  fluid  existed  in  the -peritoneal  cavity;  the 
chylopoietic  viscera  were  much  congested ; the  kidneys 
were  of  remarkable  magnitude,  and  their  cortical  sub- 
stance underwent  fatty  degeneracy. 

From  a general  view  of  the  case  I feel  satisfied  that 
this  patient  might  have  lived  some  years,  had  he  submit- 
ted to  the  treatment  I proposed  to  him  on  his  change  for 
the  worse. 


CASE  III. 

CONSUMPTION,  IN  ITS  VERY  ADVANCED  STAGE,  SINGULARLY  ARRESTED. 

W.,  clerk  in  a counting  house  in  the  city,  aged 

25, — for  whom  my  advice  was  solicited  by  Dr.  Tuke, 
the  humane  and  talented  proprietor  of  Sidney  House, 
Homerton,  the  best-regulated  private  establishment  for 
the  insane  I have  ever  visited, — when  first  seen  by  me, 
had  been  for  some  months  affected  with  cough,  and  ex- 
pectoration of  thick,  yellow  sputa.  He  was  extremely 
pallid,  and  much  emaciated,  perspired  profusely  at  night, 
and  had  occasionally  been  subject  to  heemoptysis.  It 
appeared  that  he  had  recently  lost  a brother  by  the  same 
complaint:  this  circumstance,  as  was  natural,  seemed  to 
prey  upon  his  mind,  and  depress  his  spirits  ; and  to  so 
low  a condition  was  he  reduced,  that  he  was  given  over 
by  a respectable  surgeon-apothecary  who  had  attended 
him.  I detected  distinct  pectoriloquism  on  the  anterior 
and  upper  part  of  both  sides  of  the  chest ; and  this  phe- 
nomenon, together  with  a strong  gurgling  sound,  most 
audible  in  the  left  side,  was  clearly  perceptible,  over  the 
whole  space,  from  the  top  of  the  shoulders  to  the  third 
rib.  From  partial  indistinctness  of  the  respiratory  mur- 
mur, without  the  rale  of  pneumonia  in  the  lower  part  of 
the  right  side,  I apprehended  that  nodules  of  tubercles 
were  disseminated  throughout  its  lung.  I ordered  the 


120 


APPENDIX. 


application  of  leeches  to  his  chest,  with  a view  to  lessen 
perspiration,  and  remove  congestion  and  morbid  sensi- 
bility of  the  chest : and  having  described  to  him  the 
species  of  apparatus  for  inhalation  I wished  him  to  use, 
he  procured  for  himself  a tube  of  half  an  inch  in  diame- 
ter, and  furnished  with  a stop-cock,  by  turning  which 
he  was  enabled  to  increase,  or  diminish,  the  resistance 
to  the  egress  of  air  from  the  chest.  With  very  little 
medicine,  and  that  merely  to  regulate  his  stomach  and 
bowels,  a striking  amendment  was  soon  visible,  through 
the  beneficial  effects  of  the  above  mechanical  exercise. 
His  progress  to  recovery  being  now  rapid  and  decided, 
I recommended  him  to  repair  to  the  country  for  a short 
time,  and  to  continue  the  plan  from  which  he  had 
already  derived  such  benefit.  After  some  weeks’  resi- 
dence, he  returned  to  town  well  enough  to  resume  his 
employment,  and  exhibited  every  appearance  of  health. 
He  had  gained  flesh  in  a surprising  degree,  his  muscles 
were  firm  and  developed,  his  cough  and  expectoration 
had  almost  left  him,  and  he  was — comparatively  speak- 
ing— a vigorous  man.  The  only  time  I saw  him  after 
his  return,  I examined  his  chest,  and  the  result  was,  on 
the  whole,  satisfactory.  Pectoriloquism,  indeed,  could 
still  be  detected  in  both  sides  of  the  chest ; but  in  the 
right  it  was  imperfect:  in  the  left,  however,  it  was 
extensively  manifested,  though  in  a less  degree  than 
before,  and  had  a metallic  sound.  From  this  last  cir- 
cumstance, I inferred  that  the  lining  membrane  was 
acquiring  a semi-cartilaginous  structure,  which  I have 
found  in  many  individuals  will  remain  insensible,  and  be 
productive  of  but  trifling  inconvenience  for  a series  of 
years.  It  unfortunately  happened,  that  at  no  long  pe- 
riod after  his  convalescence,  he  was  attacked  with  pleu- 
risy, probably  from  neglecting  himself ; and  although  he 
survived  this  latter  affection,  as  I was  given  to  under- 
stand, for  two  months,  yet  not  applying  for  advice,  he 
ultimately  sunk  beneath  its  effects. 


APPENDIX. 


121 


CASE  IV. 

pulmonary  excavation,  discharging  its  contents  by  an 

OPENING  MADE  IN  THE  RIGHT  SIDE  OF  THE  NECK. 

In  1822,  a child,  nearly  two  years  old,  whose  father 
was  an  out-door  patient  of  the  Infirmary,  was  brought 
for  my  advice,  labouring  under  cough,  as  well  as  a rare 
disease,  known  under  the  name  of  pemphigus,  which 
commenced  behind  the  right  ear,  with  the  eruption  of 
vesicles,  about  the  size  of  almonds  ; and  these  succes- 
sively extended  themselves  some  way  down  the  back 
and  the  same  side  of  the  neck,  discharging  acrimonious 
yellow  serum,  and  forming  deep  pits  in  the  skin.  This 
almost  intractable  disease  yielded,  at  last,  to  varied 
treatment,  and  the  application  of  an  ointment  composed 
of  the  scrofularia  nodosa.  The  part  that  had  been  af- 
fected with  the  disease  healed  up  like  a burned  surface, 
but  with  several  depressions.  The  delicacy  brought  on 
by  this  disorder,  terminated  in  tubercular  formations  in 
the  summit  of  the  right  lung,  which  finally  softened  and 
made  a way  for  themselves  by  forcing  a passage  under 
the  clavicle — the  matter  approaching  the  middle  of  the 
neck,  in  the  direction  of  the  cicatrized  integuments. 
Observing  that  every  time  the  child  coughed  a puffing 
up  of  this  part  took  place,  and  that  there  was  air  within 
it,  I directed  Mr.  Sturkey,  the  intelligent  surgeon-apo- 
thecary of  the  establishment  at  that  time,  to  make  an 
opening  here,  when  there  immediately  issued  a consi- 
derable quantity  of  air  and  matter,  with  great  relief  to 
the  little  sufferer.  This  discharge  ceased  after  some 
days : but  in  consequence  of  the  extreme  debility,  in- 
duced by  two  diseases  occurring  in  a short  space  of 
time,  the  child,  originally  of  delicate  constitution,  did 
not  survive  beyond  two  weeks.  Its  death,  indeed,  was 
absolutely  owing  to  a complete  prostration  of  vital 
power,  not  to  be  restored  either  by  nourishing  diet,  or 
tonic  remedies.  On  examination  there  were  several  tu- 
bercles in  both  lungs,  but  the  surfaces  of  the  large 
cavity  were  found  to  be  in  apposition,  and  in  more  than 
one  point  slightly  adherent ; affording  a proof,  evi- 
denced likewise  by  the  voluminous  state  of  the  Iimcfs, 

16 


122 


APPENDIX. 


that  had  the  child  lived,  it  would  have  triumphed  over 
every  consumptive  tendency.  I must  not  omit  to  men- 
tion, that  the  mesenteric  glands  were  so  enlarged,  as  to 
present  a decided  obstruction  to  proper  nutrition  of  the 
body. 


CASE  V. 

CONSUMPTION  CURED  BY  PARACENTESIS. 

Mr.  G.  S.,  aged  30,  residing  in  Norfolk-street,  Strand, 
having  experienced  several  severe  losses  in  trade,  fell 
into  a declining  state,  which  ultimately  led  to  confirmed 
consumptive  symptoms.  It  appeared  that  about  three 
years  previous  to  my  attending  him  he  had  laboured 
under  phthisis,  from  which  it  would  seem  that  he  reco- 
vered ; and  his  recovery  took  place,  as  I have  reason  to 
believe,  from  the  occurrence  of  bronchial  affection,  which 
after  a time  deserted  him.  However,  meeting  with  new 
calamities,  he  relapsed  into  his  former  phthisical  condi- 
tion. At  the  time  he  first  sought  my  advice,  every  sign 
indicated  that  his  malady  had  made  considerable  progress. 
From  the  history  of  his  case,  I concluded  that  a se- 
condary eruption  of  tubercles  must  have  taken  place  at 
least  eighteen  months  before  ; and  that  the  softening  of  a 
tuberculous  mass  of  large  size  had  led  to  the  formation 
of  a vomica.  At  times  he  was  sensible  of  fullness  in 
the  upper  region  of  the  left  side  of  the  chest,  as  if  produced 
by  accumulation  of  matter  in  the  cavity,  unable  to  find  an 
exit ; and  he  would  suddenly  be  relieved  by  expectorating' 
a quantity  of  purulent  secretion,  sufficient  to  fill  a small 
tea-cup.  He  could  himself  distinguish  the  agitation  of 
the  fluid  in  his  chest,  when  he  coughed.  On  examina- 
tion with  the  ear,  extensive  pectoriloquism  was  audible, 
extending  from  beneath  the  clavicle  to  below  the  third  rib, 
and  I distinctly  recognized  the  gurgling  of  the  fluid 
over  the  whole  of  the  upper  part  of  the  left  side  of  the 
chest.  I succeeded  in  removing  for  a time,  in  a great 
measure,  well-marked  hectic  fever,  and  the  abundant  ex- 
pectoration was  somewhat  lessened.  The  fluctuations 
from  amendment  to  relapse  were  frequent ; and,  among 
other  remedial  measures  I advised  him  to  go  to  the 
north  of  England  by  sea,  conceiving  that  he  might 


APPENDIX. 


123 

derive  benefit  from  the  bracing  qualities  of  the  air.  Re- 
maining there  a brief  period,  he  returned  to  London  but 
slightly  improved  in  health.  Convinced  that  medicine 
could  only  afiford  temporary  relief,  and  being  satisfied 
that  his  right  lung,  with  the  exception  of  old  cicatriza- 
tion, was  sound,  and  that  the  inferior  lobe  of  the  left 
lung  was  in  a very  satisfactory  state,  I ventured  to  pro- 
pose an  operation  to  him.  In  spite  of  the  ridicule  thrown 
upon  the  proposal  by  a medical  acquaintance  of  his,  he 
reposed  such  entire  confidence  in  me  that  he  unhesi- 
tatingly agreed  to  it.  Indeed,  no  accident  ever  attended 
the  operation  as  performed  by  me,  except  in  a case  of 
empyema,  occurring  in  my  early  practice  ; the  particu- 
lars of  which  extraordinary  case  I unreservedly  stated  to 
a medical  society  in  this  city.  Laennec  gives  an 
instance  not  dissimilar  from  that  which  happened  to  me, 
since  both  arose  from  an  unnatural  position,  in  my  case 
an  unheard-of  one,  of  an  important  viscus. 

Attended  by  one  of  my  pupils,  I operated  with  entire 
success.  The  trochar  was  introduced  by  me  between 
the  second  and  third  ribs,  in  a line  nearly  perpendicular 
with  the  left  nipple  : very  little  matter  escaped,  as  I had 
expected  ; for  my  chief  object  in  performing  this  opera- 
tion was  to  ensure  the  emission  of  the  air,  and  thus  effect 
a diminution  of  the  cavity  by  the  expansion  of  the  inferior 
lobe  of  the  left  lung.  I kept  the  punctured  place  open 
for  about  ten  days  by  the  introduction  of  a small  piece 
of  catgut,  properly  secured  externally ; when,  finding 
that  the  cavity  became  so  contracted,  through  the  en- 
croachment made  on  it  by  general  pulmonary  expansion, 
as  to  preclude  all  further  escape  of  air,  I withdrew  it. 
About  this  time,  a catarrhal  affection  of  the  inferior  lobe 
of  the  punctured  side  supervened  ; and  I could  tell  by 
the  ear,  that  the  pulmonary  tissue  in  the  summit  of  the 
same  side  was  undergoing  expansion.  In  less  than  two 
months  my  patient  was  able  to  go  out,  and  had  com- 
pletely lost  all  his  phthisical  symptoms.  In  less  than 
two  years  after  the  operation  he  was  in  the  enjoyment 
of  excellent  health,  the  only  drawback  being  the  exist- 
ence of  catarrh,  to  which  he  more  immediately  owes  his 
recovery. 


124 


APPENDIX. 


CASE  VI. 

CONSUMPTION  CURED  BY  SUDDENLY  SUPERVENING  EMPHYSEMA. 

A YOUNG  lady,  daughter  of  a highly  respectable  trades- 
man in  Little  Britain,  (London,)  long  subject  to  a nervous 
disorder  for  which  various  advice  had  been  taken  with- 
out permanent  effect,  became  consumptive.  Her  decline 
was,  in  my  opinion,  brought  on  by  an  ill  regulated  use 
of  medicine.  After  long  manifestation  of  the  various 
symptoms  of  phthisis,  it  was  proposed  to  me  to  meet  in 
consultation  a physician  belonging  to  one  of  the  metro- 
politan hospitals.  The  view  of  the  case  taken  by  this 
gentleman  was  so  unfavourable,  he  unhesitatingly  gave 
it  as  his  opinion  to  her  parents — that  she  could  not  sur- 
vive six  weeks.  Careful  exploration,  however,  of  the 
summit  of  the  left  lung,  where  I suspected  the  presence 
of  a cavity,  convinced  me  of  the  probable  error  of  his 
conclusion.  This  belief,  on  my  part,  originated  in  de- 
tecting decided  indications  of  emphysema  from  a dry 
crepitous  rattle,  with  large  bubbles,  manifested  by 
auscultation.  This  emphysematous  state,  I conceive, 
arose  from  a spasmodic  attack  of  the  throat,  so  violent 
as  almost  to  produce  suffocation.  From  this  circum- 
stance, combined  with  the  suddenness  of  the  emphysema, 
I inferred  that  a rupture  of  several  air-cells  had  taken 
place,  and  that  in  time  cicatrization  would  be  effected 
through  the  consequent  pulmonary  dilatation.  Nor  did 
my  conjecture  prove  erroneous  ; since,  thought  five  years 
have  elapsed  from  the  period  of  which  I am  speaking,  I 
am  most  happy  to  state,  that  this  young  lady  is  not  only 
living,  but  is  in  the  enjoyment  of  excellent  health. 


CASE  VII. 

CONSUMPTION  CURED  BY  NEGLECT. 

A SILVERSMITH,  when  in  good  health  and  circum- 
stances, and  nearly  fifty  years  of  age,  was  exposed  to 
one  of  the  most  terrible  of  all  paternal  inflictions — the 
misconduct  and  subsequent  legal  punishment  of  his  son. 


APPENDIX. 


125 


The  young  man,  having  formed  dissolute  connections, 
had  been  persuaded  to  pass  a forged  note  ; and,  on  the 
fact  being  proved  against  him,  v^as  sentenced  to  trans- 
portation. The  disgrace  thus  brought  on  their  hitherto 
unimpeachable  family,  operated  so  powerfully  on  the 
feelings  both  of  the  father,  and  of  a daughter  just  enter- 
ing into  life,  that  their  distress  and  agony  of  mind  at 
last  entirely  undermined  their  health.  The  debility  thus 
induced  terminated  in  each  of  them  in  consumption. 
After  a few  months’  illness  the  daughter  died ; and  the 
father,  after  extreme  suffering,  both  of  body  and  mind, 
having  apparently  reached  the  verge  of  the  grave,  and 
being  indeed  so  utterly  reckless  of  life,  which  he  regarded 
only  as  a burden,  as  to  neglect  not  only  recourse  to 
medical  advice,  but  even  common  care  of  himself,  yet 
recovered,  and  survived  for  many  years.  It  was  fully 
seventeen  years  subsequent  to  this  seemingly  miraculous 
recovery,  that  I attended  him  on  the  occasion  of  his 
being  seized  with  an  apoplectic  fit,  resulting,  as  I after- 
ward had  reason  to  believe,  from  valvular  disease  of 
the  heart.  During  his  convalescence  from  this  attack, 
he  was  unfeelingly  taunted  by  some  brute  in  human 
shape  with  his  son’s  disgrace ; and  so  wounded  and 
humiliated  did  he  feel  by  this  unworthy  allusion,  and  so 
deeply  did  it  sink  into  his  mind,  that  I entertain  no  doubt 
it  accelerated  his  death.  It  was  during  my  attendance 
on  him,  that  learning  from  his  wife  his  previous  con- 
sumptive state  and  recovery,  and  perceiving  that  he 
laboured  under  a bronchial  affection  of  long  standing, 
I at  once  attributed  the  return  to  health  w^hich  she  re- 
garded as  so  strange,  to  the  ingression  of  catarrh  on 
phthisis.  The  'post-mortem  examination  verified  my 
conclusions  ; it  presented  well  defined  cicatrizations, 
especially  on  the  summit  of  the  right  lung ; nodules  of 
tubercles,  yellow  and  opaque  in  the  centre,  and  rendered 
inert  by  the  secretion  of  black  pulmonary  matter  in  the 
surrounding  tissue ; and  the  lungs  were  exceedingly 
voluminous.  I will  venture  one  observation  on  the  case, 
and  although  it  may  appear  harsh,  regard  for  truth  and 
the  advancement  of  medical  science  compel  me  to  make 
it;  namely,  that  had  this  person  when  reduced  to  a 
phthisical  state  recurred  to  medical  advice,  the  probability 
is,  that  the  bronchial  affection,  which  was  his  safeguard, 


126 


APPENDIX. 


would  have  been  interfered  with,  its  value  being  unknown 
to  the  profession,  and  his  life,  consequently,  shortened 
for  years. 


CASE  VIII. 

CONSUMPTION  SPONTANEOUSLY  CURED. 

Miss  M , about  twenty-three  years  of  age,  a lady 

of  great  personal  attractions  and  highly  cultivated  mind, 
consulted  me  in  the  summer  of  1826,  for  symptoms  of 
confirmed  consumption ; for  which  she  had  already  en- 
joyed the  benefit  of  Mr.  Howship’s  advice.  It  was  ar- 
ranged that  I should  visit  her  in  conjunction  with  this 
talented  surgeon ; and  we  continued  to  attend  her  for 
several  weeks.  In  all  the  cases  I have  witnessed,  I 
never  met  with  such  distressing,  racking,  and  perpetual 
cough.  We  tried  every  method  of  relief  we  could  pos- 
sibly devise,  and  administered  sedatives  of  every  des- 
cription, but  without  effect.  Her  disorder,  instead  of 
receiving  mitigation,  evidently  increased ; and  not  only 
were  the  fears  of  her  friends  awakened,  but  we  ourselves 
began  to  despond.  At  this  crisis,  through  the  importu- 
nity of  some  near  connections,  her  mother  was  persuaded 
to  try  the  advice  of  an  individual,  who,  although  I am 
not  aware  that  he  had  received  a regular  medical  educa- 
tion, enjoyed  some  notoriety.  On  receiving  a delicate 
intimation  to  this  effect,  and  being  of  course  inclined  to 
humour  the  natural  anxiety  of  a parent,  we  agreed  that 
it  might  not  be  totally  infra  dignitatem  of  us,  the  more 
legalized  authorities,  to  hear  what  this  person  might 
suggest,  although  a formal  consultation  was  out  of  the 
question.  To  do  him  justice,  we  found  his  opinions 
sensible,  and  much  to  the  purpose  ; but  he  considered 
the  condition  of  the  patient  as  so  hopeless  that  he  declined 
interfering  with  the  case.  Yet,  notwithstanding  these 
grave  prognostics,  the  young  lady,  to  our  great  satisfac- 
tion, soon  after  this  began  to  exhibit  signs  of  amendment. 
Her  health  was  gradually  restored,  and  continues,  I be-  * 
lieve,  unimpaired  up  to  the  present  time.  From  my 
further  experience,  and  from  cases  which  have  subse- 
quently come  under  my  notice,  I entertain  no  doubt  that 
the  cough  I have  already  alluded  to,  and  which  was  of 


APPENDIX. 


127 


a convulsive  character  like  that  of  the  whooping-cough, 
must  have  produced  a rupture  of  the  air  cells,  which 
caused  infiltration  of  air  within  their  partitions.  This 
variety  of  emphysema,  similarly  to  the  vesicular,  renders, 
while  it  lasts,  the  lungs  voluminous  ; and  when  happen- 
ing in  the  neighbourhood  of  the  diseased  summit  of  the 
lung,  would  naturally  bring  the  surfaces  of  any  excava- 
tion into  contact.  Indeed,  although  from  my  reluctance 
to  put  the  patient  to  inconvenience  by  examining  the 
chest  in  the  latter  part  of  her  illness,  I could  not  posi- 
tively affirm  the  existence  of  emphysema,  still  all  my 
reflections  on  the  case  lead  me  to  the  belief,  that  she  is 
in  no  small  degree  indebted  for  her  cure  to  a cough, 
which  in  general  would  be  considered  highly  injurious, 
and  in  fact  appeared  so  to  me  at  the  time. 


CASE  IX. 

REMARKABLE  INFLUENCE  OF  THE  PROTECTIVE  POWER  OF  A 
BRONCHIAL  AFFECTION. 

I OFFER  this  case  as  one  instance  out  of  many,  equally 
as  decisive  which  I could  adduce,  of  the  value  of  catarrh 
in  preventing  pulmonary  consumption.  An  eminent 
publisher  of  Paternoster-row,  all  of  whose  brothers  and 
sisters  have  been  the  prey  of  consumption,  is  himself 
subject  to  asthma,  induced  by  a catarrhal  affection  of 
the  chest  contracted  in  childhood.  The  gentleman  to 
whom  I allude  is  at  present  about  fifty  years  of  age,  of 
a ruddy,  healthy  complexion,  expanded  chest,  and  ex- 
cepting occasional  inconvenience  experienced  from  the 
above  constitutional  complaint,  he  enjoys  life  in  every 
respect.  It  is  but  fair  then  to  infer  that  since,  out  of  a 
numerous  family,  he  is  the  sole  member  who  has  escaped 
phthisis,  this  singular  exemption  has  been  owing  to 
what  might  to  a superficial  observer  appear  an  infliction, 
but  which  is  really  in  this  instance  a providential  dis- 
pensation ; namely,  catarrhal  asthma. 

Being  thus  naturally  led  to  the  subject,  I take  the 
opportunity  of  explaining  a very  remarkable  phenome- 
non, exhibited  in  the  offspring  of  consumptive  and  asth- 
matic individuals.  That  consumption  is  hereditary,  I 


128 


APPENDIX. 


have  already  noticed ; but  an  additional  confirmation 
not  only  of  this  fact,  but  of  the  truth  of  the  opinions  I 
have  given  on  the  preventive  nature  of  catarrh,  may  be 
found  in  the  circumstance  often  noted  by  me, — that  when 
a consumptive  individual  becomes  asthmatic,  the  children 
born  prior  to  the  supervention  of  asthma  exhibit  a 
phthisical  diathesis,  while  those  who  are  born  subse- 
quently are  entirely  free  from  any  consumptive  tendency. 
Exceptions  may  undoubtedly  be  met  with,  the  result  of 
some  strong  exciting  cause  ; but,  generally  speaking,  the 
rule  will  be  found  to  hold  good : the  exception,  indeed, 
will  substantiate  the  rule,  from  the  resistance,  in  such 
cases,  offered  by  nature  to  the  inroads  of  consump- 
tion. 


CASE  X. 

COMPLICATION  OF  DISEASE  ENDING  IN  PHTHISIS. 

C.  L.,  aged  50,  the  matron  of  a medical  institution, 
and  who  consequently  had  the  best  advice  within  her 
reach,  and  was  visited  by  several  eminent  medical  men, 
was  for  some  months  subject  to  distressing  uneasiness 
and  irritability  of  stomach,  which  prevented  the  due  re- 
tention of  food.  It  being  supposed  that  she  laboured 
under  a cancerous  affection  of  this  organ,  various  palli- 
ative expedients  were  resorted  to.  Her  health,  however, 
declined,  and  she  became  subject  to  frequent  cough 
from  which  she  had  hitherto  been  free, — to  shortness  of 
breath,  purulent  expectoration,  much  emaciation,  hectic 
fever,  and  night  sweats.  After  great  suffering  for  a 
lengthened  period,  she  sank  under  this  seemingly 
double  affection  of  the  stomach  and  chest.  On  exami- 
nation, however,  of  the  body,  the  cause  of  this  train  of 
disease  was  discovered  to  be  a polypus  of  the  womb, 
which  had  considerably  enlarged  it,  and  had  undoubtedly 
excited  that  morbid  sensibility  of  the  stomach  which,  de- 
ranging the  general  health,  induced  phthisis.  The  only 
remarkable  appearances  presented  by  the  stomach, 
were  several  small  opaque  glands  in  the  mucous  surface, 
near  the  pylorus.  The  lungs  were  excavated,  and  tuber- 
culous ; and,  exhibited  marks  of  inflammation  in  various 
places.  I have  introduced  this  case  to  prove  the  just- 


appendix. 


12^ 


Mess  of  the  views  1 have  taken  in  the  preceding  portion 
of  this  work,  with  respect  to  the  fatal  supervention  of 
phthisis  on  general  debility,  when  unchecked  by  catarrh, 
or  mechanical  expansion  of  the  chest.  Had  inhalation 
been  early  employed,  the  disease  would  have  been  at 
once  arrested ; and  the  patient  might  have  lived  until 
the  appearance  of  the  polypus  through  the  external 
opening  of  the  womb  would  have  attracted  notice,  w hen 
means  might  have  been  adopted  for  its  removal. 

I have  by  me  numerous  cases  in  which  consumption 
has  fatally  supervened  on  diseases  both  of  a curable  and 
incurable  kind  ; but  their  description  could  only  confirm 
what  I have  already,  I trust,  established. 


CASE  XL 

THE  PROTECTING  INFLl/ENCE  OF  CATARRH,  SUPERVENING  ON  CON« 
SUMPTION,  EXEMPLIFIED. 

Mrs.  Hawkes,  the  wife  of  a gentleman  attached  to 
the  Bank  of  England,  who  had  been  under  the  care  of  a 
retired  lecturer  on  midwifery  at  our  largest  hospital, 
without  relief  of  her  consumptive  symptoms,  applied  to 
me  about  twelve  years  ago.  She  suffered  from  hectic 
fever,  spitting  of  blood,  and,  in  short,  exhibited  all  the 
well-known  symptoms  of  phthisis.  At  this  time,  my 
view^s  of  treatment  of  consumption  were  not  matured. 
However,  I succeeded  in  rendering  her  disease  chronic  : 
and  soon  after  this  change  was  effected,  a bronchial  af- 
fection supervened.  Until  the  pulmonary  cavity  was 
perfectly  healed,  she  was  liable  at  long  intervals  to 
sanguineous  expectoration  ; and  her  health  consequently 
exhibited  occasional  fluctuation.  During  one  of  these 
temporary  relapses,  she  consented,  in  order  to  oblige  a 
friend  whose  importunities  were  unceasing,  although  at 
the  same  time  her  confidence  in  me  continued  unshaken, 
to  apply  to  Dr.  Mat  on,  the  late  physician  to  their  royal 
highnesses,  the  duchess  of  Kent  and  the  princess  Vic- 
toria. Like  other  physicians  of  the  same  standing,  he 
possessed  no  very  accurate  knowledge  of  the  modern 
improvements  in  the  art,  and,  from  the  defective  educa- 
tion which  prevailed  when  he  commenced  his  studies, 
had  probably  never  turned  his  attention  to  pathological 

17 


130 


APPENDIX. 


researches.  At  least,  1 cannot  otherwise  account  for  his 
mistaken  views  of  the  present  case.  I do  not  intend  re- 
flecting on  Dr.  Maton  in  particular,  more  especially  as 
he  is  now  no  more.  He  was  quite  equal  to  any  of  the 
practitioners  of  his  day,  and  having  had  the  honour  to 
prescribe  for  two  successive  queens,  was  known,  like 
most  of  those  who  have  enjoyed  similar  posts,  by  his 
preferment  chiefly.  The  duties  of  the  station,  doubtless, 
preclude  the  possessors  from  making  contributions  to 
medical  science,  or,  at  least,  from  extending  their  fame 
to  foreign  countries  : a rather  singular  exception,  in- 
deed, to  what  occurs  elsewhere,  since  we  find  that 
abroad  those  medical  men  who  hold  similar  posts  are 
the  most  distinguished  by  their  professional  attainments. 
To  return  to  the  case.  Dr.  Maton  gave  it  as  his  opinion 
that  recovery  was  impossible.  This  was  accordingly 
reported  by  my  patient  to  me,  with  apologies  for  the  ap- 
parent want  of  confidence  in  my  skill.  I soon  reasoned 
her  out  of  her  fears,  and  carefully  putting  by  the  pre- 
scription, she  proceeded  in  better  spirits  from  my  assu- 
rances to  order  mine  to  be  made  up.  The  usual  results, 
attendant  upon  catarrh  in  pulmonary  consumption,  were 
not  belied  in  her  case.  She  is  at  this  moment  ever 
ready  to  join  in  the  laugh  with  me  at  her  former  trepi- 
dation ; and  is  one,  out  of  hundreds  of  instances  that 
have  passed  under  my  observation,  of  the  cures  effected 
by  the  interposition  of  nature  herself. 


CASE  XII. 

CONSUMPTION  CURED  NOTWITHSTANDING  EXPOSURE  TO  COLD  AND 
NEGLECT  OF  MEDICINE. 

Mr.  D , aged  24,  had  so  materially  impaired  his 

constitution  throuo^h  irreofular  habits  as  to  fall  in  conse- 
quence  into  a decline.  He  of  course  availed  himself  of 
the  benefit  of  medical  advice,  which  produced  no  very 
visible  amelioration  of  his  state  of  health.  Being  natu- 
rally of  active  habits,  he  grew  impatient  of  the  confine- 
ment to  which  he  was  subjected,  and,  tempted  by  the 
return  of  spring,  he  suddenly  deserted  his  heated  apart- 
ment, and  determined,  since  he  concluded  he  must  die, 


APPENDIX. 


131 


to  die  in  the  manner  most  agreeable  to  himself.  Accord- 
ingly he  betook  himself  to  his  favourite  sport  of  fishing. 
This  was  in  the  month  of  March,  a period  at  which 
easterly  winds  are  most  prevalent.  The  worst  conse- 
quence of  this  apparently  rash  exposure  was,  that  after 
a time  he  caught  a cold,  which,  as  it  would  appear,  was 
confined  to  the  trachea.  His  respiration  was  sensibly 
affected,  and  he  laboured  under  a distressing  fulness  of 
the  chest.  He  had  continued  subject  to  this  affection,  with 
an  apparent  increase  of  the  violence  of  his  disorder ; but 
he  still  rejected  all  care  and  medicine,  and  persevered 
in  going  out.  After  some  period,  he  began  to  exhibit 
signs  of  amendment ; he  gradually  lost  his  emaciated 
appearance,  and  acquired  flesh  and  bodily  vigour ; but 
w^as  much  annoyed  of  wheezirig  of  the  chest,  and  loud 
rattle  in  the  throat.  He  had  remained  in  this  state  for  some 
months,  when  he  applied  to  me.  On  examination  of  the 
chest,  and  hearing  a detail  of  his  complaints,  not  only 
from  himself,  but  from  the  gentleman  under  whose  care 
he  had  perviously  been,  I at  once  perceived  that  he  was 
indebted  for  his  recovery  from  consumption  to  this  ca- 
tarrhal state  of  the  trachea.  I may  here  observe,  that  re- 
coveries of  this  kind  are  more  frequent  among  the  lower 
than  the  other  classes  of  the  community  ; owing,  doubt- 
less, to  what  may  at  first  appear  a misfortune,  but  is  to 
the  consumptive  patient,  in  numerous  instances,  a bless- 
ing— exposure  to  cold  ! 


CASE  XIII. 

CASE  OF  CONSUMPTION,  EXEMPLIFYING  THE  GREAT  VALUE  OF 
INHALATION. 

A GENTLEMAN,  aged  fifty,  whose  house  of  business 
is  in  Hatton-garden,  began  to  exhibit  decided  symptoms 
of  consumption  about  three  years  ago.  Originally  of 
delicate  constitution,  and  inclined  by  his  make  to 
phthisical  disorder,  his  health  was  undermined  by 
family  afflictions.  Within  a very  brief  period  he  lost 
his  wife  and  two  grown-up  daughters ; the  two  latter 
through  the  same  destructive  complaint,  which,  super- 
vening on  the  decay  of  health  occasioned  by  grief  for  . 


132 


APPENDIX 


their  loss,  has  since  endangered  his  own  life.  At  the 
time  I was  called  in  he  exhibited  the  physical  signs,  as 
w^ell  as  constitutional  symptoms  of  the  disease.  He  had 
inflammation  of  the  inferior  and  middle  lobe  of  the  right 
lung,  and  expectorated  no  inconsiderable  quantity  of 
blood.  This  circumstance,  indeed,  is  no  infrequent  con- 
comitant of  the  above  inflammatory  state,  when  it  coex- 
ists with  tuberculous  excavations  of  the  lungs.  He  had 
been  under  the  care  of  two  able  practitioners,  his 
brother-in-law,  Mr.  Wallace,  and  Mr.  Christie,  a surgeon 
in  the  neighbourhood  of  his  country  residence.  Both 
these  gentlemen  considered  their  patient  in  a most 
alarming  state  ; and  on  seeing  him,  I fully  shared  their 
apprehensions.  The  first  consideration  wus  to  subdue 
the  inflammatory  state  ; and  for  this  purpose  blood 
was  taken  from  the  arm,  and  medicines  were  likewise 
exhibited  to  further  the  end  proposed.  The  pneumonia 
continuing,  it  became  necessary  to  repeat  the  general 
abstraction  of  blood,  and  to  follow  this  up  by  the  appli- 
cation of  leeches  near  the  seat  of  the  inflammatory 
action.  By  these  depletory  measures,  the  pneumonic 
disease  lost  its  more  violent  symptoms  ; but,  after  dis- 
playing a temporary  amendment,  the  active  determina- 
tion of  blood  to  the  chest  recurred  with  its  former 
severity.  At  this  juncture,  his  brother-in-law,  Mr. 
Wallace,  who  watched  the  case  with  great  anxiety, 
considered  himself  fully  justified  in  bleeding  him  in  my 
absence,  and  that  to  some  extent.  Leeches  were  also 
repeated,  and  medicines  given,  whose  chief  action  was 
determined  to  the  kidneys.  Under  this  plan  of  treat- 
ment, he  gradually  got  rid  of  the  formidable  pneumonic 
complication,  and  it  remained  to  counteract  the  phthisic- 
al disease  alone ; which,  after  a time,  began  to  exhibit 
graver  and  more  pressing  symptoms.  In  fact,  the 
patient  was  at  this  period  in  so  lamentable  a condition, 
and  so  utterly  hopeless  of  recovery— being  rendered  ad- 
ditionally uneasy  by  the  discharges  of  blood  again 
appearing— that  he  arranged  his  affairs,  and  made  every 
preparation  which  a conscientious  man  deems  it  im- 
perative to  do,  when  looking  forward  to  the  awful 
summons.  Having  first  reduced  the  spitting  of  blood, 
and  removed  some  of  the  more  formidable  external 
symptoms  connected  with  phthisis,  I pressed  the  neces- 


APPENDIX. 


133 


sity  of  recurring  to  inhalation.  The  practice  was  novel 
to  the  other  medical  gentlemen,  but  I pointed  out  its 
rationale,  and  illustrated  my  opinions  by  the  convincing 
support  of  cases.  They  yielded  to  my  arguments,  in- 
asmuch as  their  reason  was  convinced ; yet  so  unwill- 
ingly, that  they  could  not  enlist  their  hopes  on  my  side. 
The  utmost  they  at  first  expected  was  palliation ; but 
they  could  not  bring  themselves,  as  they  have  since 
owned  to  me,  to  believe  that  inhalation  could  effect  the 
healing  of  internal  ulcers,  and  prevent  the  fresh  forma- 
tion of  tubercles.  The  trial  was  however  made  ; and 
its  result  up  to  the  present  date  has  been  attended  with 
marked  success.  In  less  than  two  months  from  the 
period  of  the  patient’s  commencing  to  inhale,  his  chest 
was  so  much  enlarged  as  to  render  it  necessary  for  him 
to  have  his  waistcoats  let  out ; and  his  general  health 
was  proportionably  amended.  It  is  now  two  years  and 
a half  since  he  began  this  process,  and  for  the  last  two 
he  has  been  enabled  to  attend  constantly  to  his  business  in 
town.  He  inhaled  for  many  months  twice  a day,  except 
at  such  times  as  slight  spitting  of  blood,  arising  from  the 
cavities  not  being  yet  entirely  closed,  has  called  for  an 
interruption.  This  is  a circumstance,  which,  although 
it  is  apt  to  occasion  alarm  in  the  patient,  is  to  be  ex- 
pected in  many  instances,  so  long  as  the  excavation 
remains.  I have  already  adverted  in  case  xi.  to  a 
similar  instance  of  sanguineous  expectoration,  which 
likewise  proved  perfectly  innocuous.  The  cure  was  in 
the  case  of  this  lady  complete  ; and  in  that  now^  under 
consideration,  I am  happy  to  be  able  to  say,  ''finis 
corona t opus'" 


CASE  XV. 

ANOTHER  CASE  CORROBORATIVE  OF  THE  EFFICACY  OF  INHALATION, 
WRITTEN  BY  THE  FATHER  OF  THE  PATIENT. 

Dinah  Marks,  of  the  Jewish  persuasion,  aged  nine- 
teen, was  suddenly  seized  with  spitting  of  blood,  in  the 
beginning  of  September,  1833.  On  application  to  a 
medical  gentleman,  he  treated  the  case  as  of  no  import- 
ance, but  prescribed  for  her ; and  she  continued  under 
his  care,  without  experiencing  any  relief,  until  the  end 
of  December.  She  was  seized  at  this  juncture  with 


134 


APPENDIX. 


sanguineous  expectoration,  similarly  to  the  first  attack ; 
and  this  was  followed  by  a violent  cough.  Nocturnal 
sweats  ensued,  accompanied  by  loss  of  appetite,  dejec- 
tion of  spirits,  and  other  common  symptoms  of  decline. 
She  drooped  visibly ; and  her  appearance  awakened  all  the 
fears  of  her  mother  and  myself.  At  this  critical  period,  I 
made  the  acquaintance  of  a person  who  had  been  in- 
debted to  you  for  restoration  from  a state  even  more 
alarming  than  my  daughter’s  ; and  I immediately  sought 
the  benefit  of  your  advice  for  her.  The  state  of  weak- 
ness to  which  she  had  been  reduced,  and  consequent 
inability  to  inhale,  prevented  her  from  deriving,  or,  rather 
perhaps,  from  exhibiting  outwardly,  much  immediate 
benefit  from  your  prescriptions  ; and  she  remained  ap- 
parently in  a very  precarious  condition.  The  spitting 
of  blood  came  on  again  in  the  beginning  of  March ; and, 
on  its  removal  by  your  treatment,  you  advised  her  at 
once  to  commence  inhaling.  From  this  moment  her 
progress  to  convalescence  has  been  rapid.  With  her 
amended  health  her  spirits  also  have  revived.  She  has 
been  enabled  to  resume  her  business  ; and  no  doubt  can 
possibly  be  entertained  of  her  ultimate  recovery.  Her 
mother  and  myself” — 

I cut  short  the  thanks  of  the  worthy  couple,  as  they 
have  nothinof  to  do  with  the  understanding  of  the  case. 
Since  the  above  was  written,  the  amendment  of  my 
youthful  patient  has  been  still  more  decisive. 


CASE  XVI. 

CASE  OF  A MEDICAL  GENTLEMAN  WHO  HAS  RECOVERED  BY  INHALATION. 

Mr.  Clements,  aged  twenty-five,  member  of  the 
Royal  College  of  Surgeons,  did  me  the  honour  to  solicit 
my  advice  more  than  two  years  ago.  I found  that  he 
laboured  under  well-marked  symptoms  of  consumption. 
Since,  however,  they  presented  no  peculiar  features,  it 
is  unnecessary  to  recapitulate  the  long  list  of  consti- 
tutional and  physical  phenomena  which  have  been  so 
often  described  in  the  preceding  pages  as  concomitants 
of  the  disease  : suffice  it  to  say,  that  I have  enjoyed  the 
satisfaction  of  seeing  him  recover ; and  that  he  chiefly 
owes  his  restored  health  to  inhalation. 


APPENDIX. 


135 


CASE  XVII. 

PROTECTING  INFLUENCE  OF  PARTIAL  EMPHYSEMA,  EXEMPLIFIED  IN 
THE  LONG  LIFE  OF  A CONSUMPTIVE  PATIENT. 

Martha  Henderson,  of  Cherry  Garden  street,  Ber- 
mondsey, first  came  under  my  care  about  thirteen  years 
ago.  She  was  at  that  time  fifteen  years  of  age.  It 
appeared  that  phthisical  symptoms  first  supervened  after 
an  attack  of  the  small  pox,  which  had  seized  her  naturally 
the  year  preceding.  The  ill  health  engendered  by  this, 
it  is  probable,  gave  rise  to  the  formation  of  tubercles  in 
the  lungs.  She  exhibited  no  signs  of  consumption  in 
her  person.  Her  countenance  was  florid,  not  flushed  ; 
and  the  emaciation  usually  witnessed  in  consumptive 
patients  was  not  observable.  The  hectic  symptoms 
were  very  irregular  and  undefined,  recurring  at  uncertain 
intervals,  and  those  far  distant.  She  was  subject  to 
cough  and  shortness  of  breath,  influenced  by  changes 
of  weather ; but  the  most  remarkable  symptom  was  the 
quantity  and  fetor  of  her  expectoration.  It  resembled 
the  matter  discharged  by  a phlegmonous  abscess,  and 
she  could  bring  it  up  at  will.  She  imagined  from  the 
peculiar  sensation  she  felt  there,  that  it  proceeded  from 
the  right  side  of  the  chest ; and,  in  point  of  fact,  a great 
sympathy  was  discernible  between  the  external  and  in- 
ternal parts  on  this  side.  A swelling,  and  induration  of, 
the  mamma,  invariably  took  place  whenever  the  matter 
collected  to  any  great  extent  within.  I have  alluded  to 
the  fetid  odour  of  the  expectorated  matter ; it  was  of  so 
rank  and  sickening  a nature,  that  her  parents,  although 
she  was  their  favourite  child,  needed  every  excitement 
that  a sense  of  parental  duty  could  give  to  enable  them 
to  live  with  her.  It  is  no  exaggeration  to  say  that  it 
contaminated  the  whole  house,  and  was  perceptible  as 
soon  as  the  street  door  was  opened.  I have  seen  my 
own  pupils  ready  to  vomit  at  the  disgust  it  occasioned, 
and  have,  used  as  I am  to  such  scenes,  been  affected  by 
it  myself  When  I first  examined  her,  she  exhibited 
the  following  symptoms : — The  sound  of  respiration 
was  barely  audible  over  the  right  side  of  the  chest,  with 


136 


APPENDIX, 


the  exception  of  a space,  about  two  inches  square,  be- 
tween the  clavicle  and  the  third  rib,  where  a loud  gur- 
gling rattle  was  heard,  caused  bj  the  intromission  of 
air  into  a cavity  containing  a quantity  of  puriforni  sputa. 
A mucous  and  sometimes  sibilous  sound  was  occasion- 
ally heard  in  some  of  the  bronchial  tubes  in  the  inferior 
region  of  the  same  lung.  The  opposite  side  of  the 
chest  gave  out  an  asthmatic  wheezing,  from  the  clavicle 
downward,  as  far  as  the  fourth  rib.  The  inferior  part 
of  the  same  side,  both  before  and  behind,  yielded  a dull 
sound  on  percussion ; and  the  respiration  was  nearly 
inaudible  over  the  same  region.  When  she  spoke,  I 
could  discover  on  the  same  side  distinct  pectoriloquism 
in  the  midst  of  this  imperfect  respiration.  After  exami- 
nation I recorded  the  following  diagnosis  : — “ Large 
excavation  in  the  superior  lobe  of  the  right  lung,  con- 
taining a quantity  of  liquid  matter ; the  rest  of  the 
lung  on  the  same  side  tuberculated ; cavity  in  the 
midrlle  of  the  inferior  lobe  of  the  left  lung,  the  remain- 
der of  the  lobe  in  a state  similar  to  the  opposite ; the 
upper  lobe  of  the  same  lung  emphysematous  through- 
out.” 

I augured,  no  long  period  after  this,  that  she  was  likely 
to  live  many  years  ; feeling  assured  that  the  asthmatic 
condition  of  the  one  lobe  of  the  lung  would  counter- 
balance the  defects,  alarming  as  they  were,  of  the  rest 
of  the  pulmonary  apparatus.  I caused  her  to  attend  on 
several  occasions,  when  lecturing  on  diseases  of  the 
chest,  to  point  out  the  phenomenon  of  a person’s  existing 
so  long  under  such  ravages  from  consumptive  disease. 
She  was  seen  several  times  at  the  Central  Infirmary,  as 
well  as  the  Infirmary  for  Diseases  of  the  Chest ; was 
well  known  to  the  two  apothecaries  of  those  establish- 
ments ; and  must  have  come  under  the  notice  of  above 
one  hundred  professional  individuals.  I was  not  aware 
for  some  short  time  after  her  first  attendance  on  me  of 
the  value  of  that  emphysematous  state,  which  I now 
recognise  as  the  preserver  of  her  life  for  so  long  a pe- 
riod. Hers  was  at  first  considered  by  me  as  a remarka- 
ble case,  from  the  circumstance  of  her  displaying  most 
of  the  external  signs  of  health  in  spite  of  her  really 
distressing  condition.  Of  late  years,  however,  I have 
learned  to  estimate  properly  this  strong  corroboration  of 


APPENDIX.  137 

the  truth  of  those  views,  whichl  have  at  last  systematized, 
and  reduced  to  proof. 

A singular  peculiarity,  connected  with  the  history  of 
the  patient,  is,  that  from  the  age  of  fifteen  to  twenty- 
two  her  personal  appearance  exhibited  no  change.  She 
displayed  the  same  girlish  look  throughout  these  years  ; 
and  it  w^as  not  indeed  until  she  had  turned  her  twenty- 
second  year  that  she  underwent  the  catemenial  crisis. 
After  this,  it  was  astonishing  how  quickly  she  acquired 
the  aspect  and  proportions  of  womanhood.  She  was 
an  occasional  patient  of  mine,  as  I have  already  stated, 
for  the  space  of  ten  years ; appplying  to  me  from  time 
to  time  whenever  she  was  in  London.  In  the  course 
of  these  years  she  experienced  several  severe  inflamma- 
tory attacks.  The  immediate  cause  of  her  death  was, 
in  fact,  a violent  pleurisy,  which  seized  her  when  on  a 
visit  to  some  friends  about  forty  miles  from  town.  She 
endured  this  as  long  as  she  could  hold  up,  without  taking 
any  medical  advice ; and  at  last  hastened  home,  and 
sent  for  me.  But  she  had  delayed  till  too  late.  Her 
tongue  was  thickly  covered  with  aphthae,  her  lips  livid, 
her  respiration  so  impeded  as  to  prevent  her  from  lying 
down,  and  accompanied  with  extreme  pain  in  the  side : 
her  extremities  were  cold,  and  she  had  occasional  hic- 
cough. I saw  that  she  was  beyond  the  reach  of  medical 
aid  ; and  the  poor  girl  expired  within  thirty  hours  after 
reaching  home. 

Dissection  thirty-six  hours  after  death. — The  right 
lung  was  adherent  throughout,  by  ancient  attachments, 
to  those  parts  with  which  (though  without  adhesion)  it  is 
naturally  in  contact.  The  summit  w^as  indented,  indu- 
rated, and  covered,  or  capped,  as  it  were,  by  a fibro-car- 
tilaginous  mass.  Highly  condensed  cellular  substance, 
of  irregular  thickness,  and  about  an  inch  and  a half  in 
length,  extended  itself  into  the  lung,  and  gave  off  several 
bonds,  of  the  same  structure,  which  ran  in  nearly  a 
horizontal  direction,  and  gradually  lost  themselves  in 
the  cellular  membrane  of  the  viscus.  The  structure 
just  described  was  probably  formed  from  the  cicatriza- 
tion of  ancient  vomicse.  In  the  same  summit  there  was 
a number  of  tubercles,  in  different  stages,  several  of 
them  surrounded  by  black  pulmonary  matter.  There 
was  a large  cavity,  nearly  opposite  the  third  and  fourth 

18 


138 


APPENDIX, 


intercostal  spaces,  containing  a calcareous  secretion  of 
the  size  of  a peach  stone  ; and  instead  of  being  lined  by 
semi-cartilaginous  membrane,  its  lining  was  composed 
of  laminae  of  the  colour  and  consistence  of  old  yellow 
wax.  The  rest  of  the  lung  contained  a multitude  of  gray- 
ish tubercles,  of  unusually  hrm  consistence,  and  of 
various  sizes  : on  cutting  it,  a quantity  of  frothy  serum 
flowed  out.  The  upper  lobe  of  the  left  lung  completely 
filled  the  cavity  of  the  chest  on  that  side ; and  when 
handled,  imparted  a sensation  different  from  the  natural 
crepitation,  and  somewhat  similar  to  that  caused  by  the 
displacement  of  some  elastic  fluid.  Its  surface  exhibited 
several  transparent  vesicles,  some  of  the  size  of  an 
almond,  evidently  dilated  air-cells.  The  dilatation  of 
the  cells  over  the  rest  of  this  lung  was  likewise  remark- 
able. On  making  a longitudinal  section  of  this  lobe,  a 
slight  trace  of  cellular  cicatrix  was  perceptible  ; and  two 
of  the  bronchial  tubes  were  considerably  dilated  from 
their  cartilaginous  termination.  The  mucous  membrane 
of  all  the  tubes,  without  appearing  highly  vascular,  was 
considerably  thickened,  and  contained  much  yellow 
opaque  matter.  The  inferior  lobe,  on  the  same  side,  on 
its  anterior  and  lateral  surface,  w^as  adherent  through 
the  medium  of  a false  membrane  a quarter  of  an  inch 
in  thickness,  containing  beneath  it  a gelatinous  sub- 
stance, transparent  and  almost  colourless.  There  \vas 
a large  cavity  with  tubercles,  similar  to  those  presented 
in  the  superior  lobe  of  the  opposite  lung,  but  not  so 
numerous  ; and  marks  of  inflammation  were  exhibited  in 
various  places.  The  above  cavity,  which  occupied  the 
centre  of  the  lobe,  and  communicated  by  a large  open- 
ing with  another  of  less  size,  had  a membranous  lining 
exactly  resembling  in  structure  that  which  I have 
described  as  appearing  in  the  excavation  of  the  right 
side. 

I entertain  no  doubt  that  there  existed  originally  a 
cavity  in  the  summit  of  the  left  lung,  along  w'ith  tuber- 
cles in  a state  of  semi-transparency  ; the  latter  of  which 
had  been  absorbed,  and  the  former  healed  by  the  first 
intention. 


appendix. 


139 


CASE  XVIII. 

CONSUMPTION  WARDED  OFF  BY  THE  PRE-EXISTENCE  OF  ASTHMA, 
WHICH  HAD  LASTED  UPWARD  OF  TWENTY  YEARS  IN  A FEMALE 
WHO  SUBSEQUENTLY  DIED  THROUGH  CANCER  IN  THE  WOMB. 

Mr.  Morgan,  a general  practitioner  of  Great  New- 
port street,  has,  on  various  occasions,  invited  me  to  ac- 
company him  to  post  mortem  examinations.  I have  had 
the  pleasure  of  pointing  out  to  him,  in  some  of  these  as- 
sociated labours,  the  cicatrices  of  cured  consumption  ari- 
sing from  enlargement  of  the  volume  of  the  lungs.  In  the 
case  now  under  consideration,  extensive  cancerous  dis- 
ease had  destroyed  a great  portion  of  the  uterus  and  the 
bladder;  had  produced  considerable  induration  of  the 
rectum,  as  well  as  obturation  of  the  external  iliac,  with 
a portion  of  the  adjoining  hypogastric  vein  on  the  right 
side  ; and  had  affected  the  whole  of  the  right  leg  and 
thigh  in  a manner  similar  to  what  is  witnessed  in 
'phlegmasia  dolens.  Notwithstanding  the  ill  health  in- 
duced by  the  continuance  of  cancer  of  the  womb,  with  the 
deplorable  accompaniments  just  detailed,  as  well  as  ex- 
hausting discharges  for  upward  of  two  years,  no  symp- 
tom of  consumption  appeared ; but  the  patient,  at  last, 
succumbed  under  general  effusion,  the  result  of  protract- 
ed debility.  On  opening  the  body,  I pointed  out  to  Mr. 
Morgan  the  asthmatic  state  of  the  lungs,  (with  cicatrices 
on  their  summits,)  which  had  acted  as  a preservative 
against  the  ingress  of  that  phthisical  condition  which, 
without  this  state,  would  in  such  a case  have  indisputably 
supervened.  I have  had  opportunities  of  showing  similar 
cases  to  several  respectable  practitioners,  and,  among 
others,  to  my  worthy  friend,  Dr.  Helsham.  My  chief 
inducement  for  mentioning  this  case,  is  to  impress  upon 
the  medical  world  the  high  advantage  of  recurring,  in  all 
instances  of  debility  occasioned  by  long  continued 
chronic  ailment,  to  mechanical  means  for  preventing  the 
sure  inroads  of  consumption,  the  consequence  of  such 
state.  Mr.  Carmichael  of  Dublin  has  indeed  affirmed  in 
the  second  edition  of  his  excellent  Avork  on  cancer,  that  he 
never  examined  the  body  of  a patient  who  died  with 


140 


APPENDIX. 


any  variety  of  that  disease  without  finding  the  lungs 
tuberculated.  This,  in  the  first  instance,  strongly  cor- 
roborates the  correctness  of  rny  opinion,  that  consump- 
tion is  a very  common  result  of  ill  health  produced  by 
any  ailments  of  long  continuance ; and,  in  the  second, 
it  shows  by  negative  testimony  the  value  of  those 
means  which  will  prevent  such  supervention.  I have 
no  doubt  that  this  gentleman,  in  the  prosecution  of  his 
pathological  studies,  will  meet  with  cases  in  which  the 
utility  of  catarrhal  and  asthmatic  affections  in  anticipa- 
ting or  arresting  phthisis  will  be  w^ell  marked : and  I 
feel  pleasure  in  adding,  that  from  his  high  character, 
and  zeal  for  the  true  interests  of  his  profession,  he  will, 
in  such  case,  I am  confident,  be  forward  to  acknowledge 
the  accuracy  of  these  observations,  already  verified  by 
me  in  numerous  examinations  after  death. 


CASE  XIX. 

CURE  OF  HEREDITARY  CO^"SUMPTION. 

Mr.  S , a gentleman  of  middle  age,  attached  to 

one  of  the  government  dock-yards,  applied  to  me  more 
than  twelve  months  ago,  after  having  been  under  the 
care  of  a physician  in  large  practice  in  the  west  end  of 
the  town.  He  presented  all  the  usual  symptoms  of  con- 
sumptive disease,  and  had  a cavity  in  the  summit  of  his 
right  lung,  where  was  well-marked  pectoriloquy.  He 
was  considerably  emaciated,  expectorated  abundantly 
matter  streaked  with  blood,  was  harassed  by  incessant 
cough,  and  perspired  profusely.  His  cough,  which  had 
made  its  appearance  simultaneously  with  the  first  symp- 
toms of  illness,  had  constantly  remained  unrelieved. 
Having  ascertained  by  auscultation  that  the  entire  of  the 
left  lung,  and  the  lower  part  of  the  right,  from  the  third 
rib  downward,  were  perfectly  healthy,  I felt  no  doubt, 
notwithstanding  his  reduced  state  and  the  time  he  had 
been  seriously  ill,  which  was  five  or  six  months,  that 
there  were  firm  grounds  for  hope.  In  conformity  with 
my  usual  plan,  I advised  the  application  of  leeches,  in 
order  to  lessen  the  hectic  symptoms,  and  mitigate  the 


APPENDIX. 


141 


violence  of  the  cough : they  were  applied  at  times  be- 
neath the  clavicle,  at  others  between  the  right  scapula 
and  the  spine.  The  medicines  ordered  were  chiefly 
diuretic  and  sedative.  After  the  leeches  had  been  em- 
ployed a few  times,  and  the  hectic  symptoms  reduced,  I 
recommended  him  to  begin  inhaling,  which  he  accord- 
ingly commenced  at  the  rate  of  'eight  or  ten  minutes, 
three  times  a day,  and  extended  the  period  by  a minute 
daily  till  he  reached  the  term  of  half  an  hour.  After 
continuino*  at  this  increased  rate  for  a short  time,  he 
complained  of  a feeling  of  soreness  in  his  chest,  possibly 
created  by  it,  and  I advised  him  to  lessen  his  term  of 
inhaling  in  the  same  manner  as  he  had  increased  it,  by 
a minute  each  time,  until  he  gradually  dropped  down  to 
the  ten  minutes  with  which  he  had  original! v begun.  I 
may  observe  that  this  course  of  alternate  increase  and 
decrease  is  often  advised  by  me,  with  the  best  results. 
In  about  four  months  after  consulting  me  he  had  become 
quite  an  altered  man.  During  this  time  his  health  had 
occasionally  fluctuated,  the  hectic  and  other  unfavourable 
symptoms  recurring  : being,  however,  always  promptly 
met,  they  produced  only  slight  interruptions  to  the  steady 
course  of  his  amendment.  These  alternations,  indeed, 
must  generally  be  expected  ; and  the  occasional  returns 
of  hectic  fever  are  sometimes  owing,  I conceive,  to  the 
softening  of  tubercles  which  have  reached,  or  are  nearly 
arrived  at  a state  of  maturity  when  the  patient'^iSm- 
mences  inhaling,  and  Vv^hich,  forcing  their  way  into  some 
of  the  bronchial  branches,  produce  an  irritation  with 
which  the  constitution  sympathizes. 

It  is  now  a year  since  I first  prescribed  for  this  patient. 
On  last  exploring  his  chest,  I could  not  discover  the 
slightest  sign  indicative  of  the  presence  of  the  cavity  I 
have  spoken  of  above  : there  was  a slight  indistinctness 
of  the  respiratory  murmur  perceptible  in  the  summit  of 
the  right  lung,  but  no  remains  whatever  of  pectorilo- 
quism. 

The  above  is  a case  of  hereditary  consumption ; and 
several  of  this  patient’s  brothers  and  sisters  have  fallen 
victims  to  the  disease.  He  is  now  actually  in  the  enjoy- 
ment of  better  health  than  he  remembers  his  ever  pos- 
sessing ; and  is  perfectly  competent  to  the  active  dis- 
charge of  business. 


142 


APPENDIX. 


I may  conveniently  place  under  the  same  head  seve- 
ral other  cases  of  the  cure  of  hereditary  consumption  ; 
and  I adduce  them  as  so  many  proofs  that  the  possibility 
of  the  cure  of  consumption  in  this,  its  worst  form,  does 
not  depend  upon  an  isolated,  or  fortuitous  instance,  but 
has  been  effected  in  various  patients  of  both  sexes  and  of 
different  ages.  I do  not  propose  entering  into  any  par- 
ticular detail  of  the  progress  of  the  complaint  in  the  re- 
spective cases,  but  shall  cite  them  as  facts  that  may  easily 
be  ascertained  by  any  of  my  readers. 

A young  gentleman,  grandson  of  a late  celebrated 
financier  and  member  of  parliament,  whose  theory  of 
rent  is  w^ell  known  to  the  political  economist,  was 
brought  to  consult  me  about  a year  and  a half  since. 
His  family  were  in  the  greatest  alarm  respecting  him,  as 
a sister  of  his  had  died  not  long  before,  who  had  pre- 
sented symptoms  precisely  similar  to  those  he  was  then 
labouring  under.  Such  was  their  alarm,  and  their  ner- 
vous apprehension  of  having  his  fears  excited,  that  they 
begged  me,  if  possible,  to  examine  his  chest  in  an  appa- 
rently unconscious  manner,  as  if  going  through  a mere 
matter  of  form,  so  as  to  avoid  awakening  suspicion  in  his 
mind  of  his  real  state.  This»  youth,  who  is  now  about 
eighteen  years  of  age,  is  quite  well. 

Miss  G , whose  father  is  a fashionable  ladies’  shoe- 

maker in  Soho-square,  had  been  deprived  of  her  mother 
by  consumptive  disease,  and  had  likewise  lost  a brother 
and  a sister  by  the  same  scourge,  all  three  within  the  two 
years  previous  to  her  consulting  me.  When  she  applied 
to  me,  this  young  lady  was  in  a most  enfeebled  state,  and 
could  hardly  walk  a dozen  yards.  Passing  over  other 
symptoms,  it  is  sufficient  to  say  that  I ascertained  the 
existence  of  a cavity  in  the  summit  of  the  right  lung. 
Miss  G.  is,  at  the  time  I now  write,  in  the  enjoyment  of 
excellent  health. 

Mr.  M.,  a gentleman  well  known  in  one  of  our  large 
manufacturing  districts,  came  to  town  to  consult  me, 
about  a year  ago.  His  case  had  been  pronounced  despe- 
rate by  tile  most  eminent  medical  man  of  the  city  in  which 
he  resides ; and  indeed,  there  was  a cavity  in  his  left  lung 
so  extensive  as  almost  to  preclude  hope.  He  w^as  daily 
visited  by  me  for  about  two  months,  and  remained  in 
town  until  the  constitutional  symptoms  were  removed. 


APPENDIX. 


143 


Returning  to  the  country,  he  continued  a regular  course 
of  inhalation.  Five  months  afterward  he  revisited  Lon- 
don, and  I begged  him  to  have  the  kindness  to  call  on 
Dr.  Waller,  lecturer  on  midwifery,  who  had  then  a deep 
interest  in  whatever  related  to  consumptive  disease,  in 
order  to  let  him  hear  the  history  and  examine  into  the 
state  of  the  case.  The  cavity  was  not  then  entirely 
healed  up  ; but  its  size  had  been  reduced  by  one  half, 
and  Mr.  M.  was  so  far  restored  as  to  be  able  to  attend  to 
the  business  of  his  factory.  My  last  accounts  from  him 
are  of  the  most  favourable  nature. 

This  gentleman,  I must  state,  has  lost  a mother  and 
sister  through  consumption. 

Some  short  time  since  Messrs.  Maw,  the  celebrated 
surgical  instrument  makers,  put  a domestic  of  theirs  under 
my  care  who  was  labouring  under  far  advanced  phthisis. 
I received  the  subjoined  letter  from  them  the  other  day, 
in  which  her  present  state  of  health  is  satisfactorily 
alluded  to. 

‘‘  The  bearer  of  this,  W.  B , a young  man 

in  our  employ,  seems  much  in  the  same  state  as  the  fe- 
male servant  of  ours  whom  you  kindly  attended  a few 
months  since,  and  who,  we  have  the  pleasure  to  inform 
you,  is  now  enjoying  a good  state  of  health.  As  he  is 
not  able  to  pay  for  medical  advice,  we  enclose  a fee,  and 
shall  feel  obliged  by  your  kind  attention  to  him. 

“We  remain  your  obedient  servants, 

“ J.  & S.  Maw. 

“11  Aldersgate-street,  May  25,  1836.” 


CASE  XX. 

CONSUMPTIVE  DISEASE  SUPERVENING  ON  DYSPEPSIA. 

Mr.  C , a highly  respectable  tradesman,  resident 

at  Brighton,  naturally  of  delicate  constitution,  fell  into  a 
most  distressing  state  of  health  through  long  protracted 
dyspeptic  disease.  The  consequences  of  this  debilitated 


144 


APPENDIX. 


condition  manifested  themselves  in  the  expectoration  of 
muco  purulent  matter,  often  streaked  with  blood  ; in 
harassing  cough  ; in  night  sweats ; in  gradual  and  almost 
complete  prostration  of  bodily  strength ; and  in  fine — 
in  confirmed  consumption.  To  so  alarming  a state  was 
he  reduced  that  the  prayers  of  the  congregation  had  been 
publicly  requested  in  his  behalf  in  the  church  which  he 
attended.  When  he  had  himself  conveyed  to  town  to 
consult  me,  he  was,  as  may  be  supposed  from  the  above 
account,  apparently  a complete  wreck.  On  exploring  the 
state  of  his  chest,  I ascertained  the  existence  of  a well- 
marked  cavity  in  the  summit  of  the  right  lung ; in  that 
of  the  left  the  respiratory  murmur  was  highly  obscure. 
It  is  unnecessary  to  detail  the  varying  symptoms  that  pre- 
sented themselves,  and  the  treatment  by  wdiich  they 
were  met;  as  this  w^ould  be  a mere  recapitulation  of 
much  that  has  gone  before.  During  the  time  that  he 
remained  in  town  under  my  care  he  suffered  several 
temporary  relapses  from  the  softening  down  of  the  tuber- 
culous deposites  previously  formed,  and  underwent  all  the 
fluctuations  common  to  the  most  trying  symptoms  of 
consumptive  disease.  These  constitutional  symptoms  had, 
of  course,  to  be  treated  as  they  arose,  at  times  by  anti- 
phlogistics,  at  others  by  sedatives,  and  occasionally  by 
tonics.  At  the  proper  juncture  he  commenced  inhala- 
tion ; and  here  I must  again  insist  upon  a point  to  which 
I have  several  times  adverted  in  the  course  of  this 
work,  that  although  inhalation  is  of  vital  consequence  in 
the  cure  of  phthisis,  yet  it  is  likewise  essential  that  the 
constantly  changing  constitutional  symptoms  be  treated 
as  they  occur  by  the  proper  remedial  measures.  Hence 
the  necessity  for  the  watchful  superintendence  of  the 
physician  skilled  in  all  the  minutise  of  consumptive  dis- 
ease, to  counteract  the  ingression  of  every  unfavourable 
symptom,  to  take  advantage  of  every  circumstance  cal- 
culated to  forward  recovery,  and  to  regulate  the  treat- 
ment, medical  and  dietetic,  according  to  the  emergency. 

No  case  that  ever  came  under  my  care  has  afforded 
more  satisfactory  proof  of  the  remedial  powders  of  inhala- 
tion, combined  with  proper  constitutional  treatment,  than 
the  present.  The  patient  was  naturally  delicate,  had 
had  his  health  so  impaired  by  indigestion  as  to  pass  into 


APPENDIX. 


14o 


a phthisical  state,  which,  becoming  confirmed,  had 
brought  him  to  the  brink  of  the  grave,  and — he  is  now 
well.  Conscientiously  can  I affirm,  and  I do  it  from  no 
impulse  of  vanity,  (for  there  is  too  much  yet  to  be  learn- 
ed for  any  right-thinking  physician  to  feel  vain,)  that 
death  must  have  been  the  result  under  any  other  system 
than  mine. 


CASE  XXI. 

IXEFFICACY  OF  REMOVAL  TO  A WARM  CLIMATE. 

Mr.  a.,  a deputy  alderman  of  one  of  the  city  wards, 
was  recommended  to  consult  me,  in  the  spring  of  1835, 
by  Alderman  Harmer.  He  had  but  lately  returned  from 
Italy,  whither  he  had  been  recommended  to  repair  for 
the  benefit  of  his  health  by  his  former  medical  adviser, 
who  was  an  assistant  physician  to  one  of  our  London 
hospitals.  This  advice  had  been  given  after  the  ascer- 
taining the  existence  of  a cavity  in  the  summit  of  the 
right  lung,  and  the  presence  of  a very  slight  catarrh.  It 
was  well  meant,  but  was  attended  by  the  usual  nuga- 
tory or  worse  than  nugatory  results,  since  during  a resi- 
dence of  some  months  his  complaint  got  worse  rather 
than  better.  Singularly  enough,  he  first  heard  my  name 
mentioned  abroad,  and  the  recommendation  he  there 
received  to  apply  to  me  was  supported,  as  I have 
just  stated,  on  his  return  to  England,  by  Alderman  Har- 
mer. On  exploring  his  chest,  I found  the  cavity  above 
mentioned  still  existing,  and  that  the  summit  of  his  left 
lung  likewise  was  in  an  unsatisfactory  state.  His  ca- 
tarrh had  yielded  to  the  influence  of  a warm  climate, 
and  the  interposition  of  nature  in  his  behalf  had  thus 
been  entirely  superseded.  His  deterioration  had  of 
course  been  sensible  to  himself,  but  he  was  not  a little 
surprised  to  be  told  that  the  only  safeguard,  artificial 
means  excepted,  which  he  could  possess  against  the  in- 
roads of  consumption,  was  the  catarrh  on  whose  removal 
he  had  congratulated  himself  It  recurred  not  long  after 
his  return ; but  since,  as  I have  already  had  occasion  to 
observe,  the  expansion  of  the  pulmonary  tissue  necessary 
to  heal  up  a cavity  is  much  more  agreeably  and  equally 

19 


146 


APPENDIX. 


effected  by  inhalation,  I of  course  would  not  trust  to  the 
dilatory  results  of  a catarrhal  cure,  and  ordered  immedi- 
ate recourse  to  the  above  mechanical  process.  The 
constitutional  symptoms  have  presented  the  usual  varia- 
tions in  the  course  of  this  gentleman’s  attendance,  and 
some  time  back,  finding  himself  much  better,  he  was 
tempted  to  comply  with  a call  upon  him  for  a song  at 
some  civic  festival,  and  a hemorrhage  was  the  result. 
About  three  months  ago  he  had  an  attack  of  what  now 
goes  under  the  appellation  of  influenza,  and  I seized  the 
opportunity  of  once  more  examining  his  chest.  The 
cavity  had  nearly  disappeared,  and  the  state  of  the  rest 
of  the  thorax  was  in  the  highest  degree  satisfactory. 
This  favourable  result  was  for  the  most  part  owing  to 
his  steady  perseverance  in  inhalation  ; since,  with  this 
exception,  he  has  been  a very  careless  patient,  negligent 
of  himself,  and  seldom  letting  me  see  him ; a circum- 
stance originating,  perhaps,  in  his  acquaintance  with  a 
clergyman  who  cured  himself  by  the  use  of  this  means 
alone.  However,  this  is  an  unsafe  example,  since  con- 
stitutional symptoms  will  often  arise  to  call  for  the  im- 
mediate, though  temporary,  suspension  of  inhalation. 

I may  here  observe  that  notwithstanding  the  super- 
vention of  catarrh  on  phthisis  is  the  mode  by  which 
nature  endeavours,  and  often  does  effect  a cure,  still  it 
is  so  far  imperfect  in  its  operation,  inasmuch  as  it  substi- 
tutes for  the  consumptive  state  a difficulty  of  breathing 
which  often  terminates  in  confirmed  asthma.  Hence  the 
superiority  of  inhalation,  which  both  acts  more  efliciently 
and  entails  no  troublesome  consequence.  Hence  too, 
although  catarrh  have  set  in  so  as  to  afford  the  benefit 
of  its  protection  to  a consumptive  patient,  I at  once 
order  recurrence  to  inhalation,  not  onlv  for  the  beneficial 
agency  it  exerts  in  phthisis  itself,  but  as  a means  of 
curing  the  catarrh.  Its  influence  over  the  last  is  partly 
owing  to  the  completeness  it  gives  to  the  expirations.  In 
catarrh  the  air  is  imprisoned,  as  it  were,  in  the  air-cells, 
and  embarrassed  breathing  is  the  result.  Inhalation  here 
steps  in  as  an  auxiliary,  and  not  only  renders  the  expi- 
rations more  perfect,  but  contributes  in  other  respects  to 
the  removal  of  the  catarrh. 

Another  benefit  of  inhalation,  and  this  is  a physical 
fact  no  less  novel  than  important,  is  the  security  it  affords 


APPENDIX, 


147 


against  the  ingression  of  pleurisies,  so  frequent,  accord- 
ing to  the  testimony  of  Laennec,  in  the  consumptive. 
The  same  exemption  from  pleurisy  is  observable  in  the 
asthmatic. 

Again,  if  from  any  cause  there  exist  empyema,  or  a 
collection  of  matter,  in  one  side  of  the  chest,  (even  for 
months,)  a state  in  which  the  lung  of  this  side  is  com- 
pressed, the  lung  of  the  other  side  undergoes  increased 
expansion.  Now  the  lung  thus  expanded,  if  previously 
healthy,  never  becomes  the  seat  of  tuberculous  deposite. 
I have  verified  this  in  several  instances ; and  this  is  a 
strong  collateral  proof  of  the  inestimable  value  of  inha- 
lation. 

To  return  to  the  “ inefficacy  of  removal  to  a warm 
climate.”  I have  never  known  a cavity  healed  by  a 
residence  in  a southern  clime,  though  I have  known 
many  a consumptive  case  fatally  confirmed  by  it.  Three 
times  did  an  officer  in  the  army  to  my  knowledge  try  a 
residence  in  Madeira : the  voyages  certainly  did  him  tem- 
porary good,  but  he  ultimately  returned  with  the  deadly 
enemy  in  his  bosom — the  cavity — as  distinctly  marked 
as  ever. 

To  the  above  cases,  which  bear  a slight  proportion 
indeed  to  the  number  I have  at  this  moment  lying  on  the 
table  before  me,  detailed  as  well  by  the  thankful  patients 
themselves  as  minuted  by  me,  I append  two  letters  from 
medical  gentlemen  illustrative  of  the  happy  results  of 
pulmonary  expansion.  The  first  of  these  stands  in  need 
of  no  other  explanation  than  my  observing  that  the 
writer  has  omitted,  that,  on  exploration  of  the  chest,  the 
physical  signs  of  consumption  were  distinctly  marked. 
Mr.  Graves,  the  brother-in-law  of  my  patient,  who  en- 
joys an  extensive  practice  in  the  east  end  of  the  town, 
and  has  been  long  accustomed  to  auscultative  examina- 
tion, fully  concurred  with  me  in  the  opinion  I expressed 
of  the  existence  of  cavities  and  entered  into  my  views 
as  to  the  plan  of  treatment  I had  laid  down. 

“Dear  Sir, 

“ In  compliance  with  your  request,  I beg  to  give 
you  the  following  statement  relative  to  my  health : — 

“ In  the  winter  of  1832  I was  troubled  with  a cough, 
after  which  my  health  continued  indifferent,  and  in  the 


APPENDIX. 


148 

month  of  May  last  I had  a violent  attack  of  pain  in  mj 
chest,  for  which  a blister  was  applied  and  medicine 
taken,  apparently  with  great  effect ; but  in  about  eight 
days  the  pain  returned  with  increased  severity.  After 
being  twice  bled  copiously  from  the  arm,  and  the  local 
application  of  leeches  and  a blister,  the  pain  was  allayed 
so  as  to  allow  of  free  respiration.  I was  now,  of  course, 
extremely  weak.  In  about  four  weeks  the  pain  again 
returned  in  my  chest.  Leeches  and  blisters  were  re- 
peatedly applied,  without  effecting  its  removal,  and  al- 
though the  general  state  of  my  health  was  of  course 
attended  to,  my  strength  of  body  soon  so  much  decreased 
that  it  was  thought  I should  not  recover.  Under  these 
circumstances,  I applied  to  yourself  in  July,  and  am 
happy  to  say  that  under  your  skilful  treatment  I soon 
began  to  amend,  and  that  for  the  last  two  or  three  months 
I have  entirely  left  off  taking  medicine,  being  now  stout- 
er and  stronger  than  before  the  commencement  of  my 
illness  in  1832.  I have  been  for  some  time  without  any 
cough. 

“Hoping  these  particulars  may  be  useful  to  you,  be- 
lieve me  to  be,  dear  sir, 

“Your  much  obliged,  humble  servant, 

“Charles  Rose. 

“24  Beaumont-square,  Feb.  5,  1834.” 

It  affords  me  much  pleasure  to  state  that  this  gentle- 
man is  in  the  enjoyment  of  excellent  health. 

The  following  is  from  a gentleman  of  the  name  of 
Langley,  a general  practitioner,  and,  as  will  be  seen,  a 
former  patient  of  mine  : — 

“ Dear  Sir, 

“ The  bearer  appears  to  me  to  have  incipient 
phthisis,  and  has  been  suffering  from  an  indomitable 
cough,  with  dyspnoea  and  nocturnal  perspirations.  I 
have  taken  blood  from  him,  used  counter-irritants  very 
freely,  and  attempted  to  abate  the  pulmonary  irritation 
by  sedatives,  combined  with  ipecacuanha  and  nitre.  His 
ill  state  of  health  has  reduced  him  so  much  in  circum- 
stances that  he  approaches  you  as  a gratuitous  patient 


APPENDIX. 


149 


Any  suggestion  you  may  be  kind  enough  to  advise  shall 
be  strictly  attended  to.  Under  your  direction  I have 
myself  recovered  my  health,  and  'svith  many  thanks  for 
your  kindness,  I remain,  dear  sir, 

Very  faithfully  yours, 

“John  Langley. 

“ 36  Tottenham-street,  Fitzroy-square.” 

It  has  so  happened,  that  'within  the  last  three  years 
I have  had  several  cases  of  consumption  in  medical 
men,  under  my  care,  and  in  nearly  every  instance  the 
result  has  proved  satisfactory. 

I subjoin  to  the  above  testimonies  to  the  value  of  in- 
halation the  following  letter  from  a professional  friend 
of  mine,  whose  abilities  need  no  encomium  from  me, 
and  who  is  very  generally  known  among  his  brethren 
from  the  circumstance  of  his  having  been  secretary  to 
the  Medical  Society  of  St.  Bartholomew’s  Hospital  some 
years  since.  The  gratification  I experienced  in  receiving 
so  powerful  a corroboration  of  my  opinions  from  so 
excellent  a judge  was  enhanced  by  its  having  been 
entirely  unexpected.  Several  years  had  elapsed  since, 
through  business,  and  the  every  day  cares  of  life,  our 
correspondence  had  ceased.  To  have  it  renewed  was 
in  itself  a pleasure,  which  was  doubled  by  the  manner 
of  the  renewal.  I shall  not  apologize  for  inserting  re- 
marks so  favourable  to  myself.  The  writer  is  too  inde- 
pendent to  have  written  any  other  than  his  conscientious 
opinion ; and  I have  not  the  false  pride  which  would 
conceal  praise  when  praise  is  honourable.  His  residence 
on  a part  of  the  coast  to  which  consumptive  patients 
are  frequently  sent  has  given  Mr.  Bowden  peculiar  op- 
portunities of  studying  the  nature  of  phthisis.  I feel 
that  he  is  well  qualified  to  pronounce  a judgment  on 
any  mode  of  treating  the  disease  which  may  be  pro- 
pounded, and  am  grateful  for  the  manly  liberality  with 
which  he  has  come  forward.  There  are  many  reasons 
for  the  opposition  to  my  views  which,  I know,  exist 
among  many  of  my  medical  brethren : disinclination  to 
unlearn  is,  perhaps,  among  the  chief  Were  it  the  only 
one,  I should  not  step  out  of  the  way  to  notice  it.  I 
should  be  well  contented  to  undergo  what  Harvey,  Syden- 


150 


APPENDIX. 


ham,  and  J enner  have  undergone  before  me.  The  thought 
of  the  future  would  indemnify  me  for  any  temporary 
annoyance,  and  I should  anchor  my  hopes  upon  the 
indisputable  axiom,  Magna  est  veritas  et  prcevalehit — 
but  unworthier  motives  have  been  at  work.  I was  one 
of  the  first,  if  not  the  first,  to  point  out  the  deficiencies 
of  the  medical  education  of  the  day ; and  had  my  sug- 
gestions been  attended  to,  many  M.  D.’s  might  have 
been  spared  the  pain  of  their  confessions  before  the 
medical  committee  lately  sitting  at  Westminister. 

**Dawlish,  Devon.j  June  20th,  1834. 

“My  Dear  Doctor, 

“ I have  just  purchased  and  read  your  book  on 
consumption  with  much  gratification.  I perfectly  coin- 
cide with  your  views,  in  every  particular,  and  am  sat- 
isfied of  their  accuracy.  It  is,  perhaps,  paying  myself 
a compliment  at  the  expense  of  my  professional  breth- 
ren to  say,  that  I have,  ever  since  I had  the  pleasure  of 
knowing  your  sentiments,  differed  from  them  as  much 
as  you  do.  With  regard  to  their  treatment  of  that  plague- 
spot  in  the  English  constitution — consumption — it  has 
ever  appeared  to  me  founded  on  false  principles,  or 
dictated  by  the  hereditary  prejudices  of  our  profession : 
of  you  they  are  particularly  jealous,  and  would  gladly 
rob  you  of  your  dearly  earned  knowledge  and  fame.  I 
call  it  dearly  earned,  for  I remember  the  many  unpleasant 
situations  we  have  been  placed  in,  among  the  haunts 
of  London  disease  and  misery,  particularly  in  the  pur- 
lieus of  Saffron  hill.  I must  say  honestly,  and  without 
flattery,  that  I never  knew  one  of  your  profession  who 
laboured  so  zealously,  and  constantly,  as  you  did  in 
post  mortem  examinations ; or  who  was  so  thoroughly 
conversant  with  morbid  appearances,  and  their  anatom- 
ical detail  and  minutise.  i have  myself  experienced  the 
accuracy  of  your  observations  in  the  persons  of  several 
of  my  own  patients  ; and  so  nearly  have  our  ideas  coin- 
cided that  I have  been  in  the  habit  of  making  my  patients 
inhale  through  an  (Esophagus  tube,  to  oblige  them  to 
inspire  deeply.  I am  quite  certain  I have  cured  two 
cases  of  tubercular  phthisis  by  your  means. 

“Very  sincerely  and  truly  yours, 

“R.  B.  Bowden.” 


APPENDIX. 


151 


It  is  about  twelve  months  ago  that  Mr.  Ward,  a gen- 
tleman practising  in  the  vicinity  of  London,  took  my 
advice  for  consumptive  disease,  at  the  suggestion  of  Dr. 
James  Blundell.  I detected  a well-marked  excavation 
in  the  summit  of  the  right  lung,  and  was  informed  by 
him  that  he  had  had  several  attacks  of  hemoptysis. 
Without  entering  into  any  details,  which  indeed  would 
present  no  novelty  either  respecting  symptoms,  or  my 
usual  practice,  I at  once  give  the  satisfactory  result, 
which  is — restoration  to  health.  I shall  conclude  these 
instances  of  cure  among  my  medical  brethren  by  ad- 
ducing the  name  of  Mr.  Paine,  son  of  the  ingenious 
inventor  of  the  illuminated  dials  now  becoming  common 
in  our  churches,  who  consulted  me  about  three  years 
since,  and  has  been  enabled  to  resume  his  profession, 
which  he  had  then  abandoned  as  beyond  his  failing 
strength. 


CASES  GIVEN  BY  DR.  HOHNBAUM  IN  THE  PREFACE  TO  HIS 
TRANSLATION  OF  ‘‘  CONSUMPTION  CURABLE.” 

Case  1.  A female,  36  years  of  age,  of  weak  and 
sickly  constitution,  skin  white  and  of  delicate  texture, 
neck  long  and  slender,  chest  confined,  complexion  very 
pale,  habitual  stoop,  had  suffered  in  childhood  from  scro- 
fula, the  glands  of  the  neck  having  frequently  suppurated. 
Her  father  is  living,  but  has  laboured  from  a boy  under 
disease  of  the  chest,  and  has  often  appeared  to  be  sink- 
ing into  a decline.  Some  years  after  her  marriage,  she 
lost  all  the  outward  signs  of  scrofula,  but  became  subject 
to  an  occasional  dry  cough,  which  would  disappear  after 
a time.  In  1833,  anxiety,  occasioned  by  the  illness  of 
her  only  child,  brought  on  a return  of  this  cough,  which, 
however,  did  not  leave  her  as  usual,  but  seemed  to  in- 
crease constantly,  and  awakened  much  apprehension. 
The  patient  was  greatly  dejected  at  this,  despaired  of  re- 
covery, lost  sleep  and  appetite,  fell  away  in  flesh,  and 


152 


APPENDIX. 


complained  of  such  extreme  weakness  as  to  be  hardly 
able  to  leave  her  bed.  The  coughing  continued  to  in- 
crease, and  was  particularly  harassing  in  the  evening, 
during  the  night,  and  on  awaking.  At  first  there  was 
no  expectoration ; but  afterward  she  brought  up  a little 
phlegm  the  first  thing  in  the  morning.  The  cough  was 
accompanied  by  pain  in  the  chest,  and  occasional 
twitches  ; her  breathing  was  short,  especially  when  going 
up  stairs,  and  was  considerably  affected  by  every  bodily 
exertion,  however  slight.  The  pulse  gave  no  indications 
of  actual  fever ; but  the  patient  complained  of  frequent 
shiverings,  with  burning  hands,  and  morning  perspira- 
tions. Her  whole  appearance  answered  to  the  commence- 
ment of  phthisis  scrofulosa. 

Having  continued  in  this  precarious  condition  for  a 
year,  reckoning  from  the  first  manifestation  of  the 
cough ; having  been  under  the  care  of  two  physicians, 
without  deriving  any  benefit ; and  having  tried  a variety 
of  medicines  to  no  purpose,  I recommended  the  system 
of  inhaling,  advocated  by  Doctor  Rarnadge.  Following 
exactly  the  rules  laid  down  in  his  work,  I ordered  her  to 
inhale  the  vapour  from  an  infusion  of  hops  in  vinegar 
twice  a day,  for  a quarter  of  an  hour  each  time.  This 
period  was  subsequently  extended  to  half  an  hour. 

The  patient  had  scarcely  tried  this  method  for  a 
week,  to  the  exclusion  of  all  others,  when  her  sleep  be- 
came sounder,  and  her  cough  seemed  less  frequent.  In 
the  course  of  another  week  it  was  perceptibly  less  so ; 
and  the  expectoration  had  diminished.  Her  respiration 
gradually  became  more  free  and  deep,  she  gained  flesh 
and  strength,  the  perspirations  left  her,  her  appetite  re- 
turned, she  recovered  her  serenity  of  mind,  and,  in  short, 
rapidly  approached  a state  of  convalescence. 

At  the  present  time,  she  has  used  inhalation  con- 
stantly for  three  months  ; the  expectoration  has  entirely 
ceased;  the  cough  too  has  almost  left  her,  being  so 
slight  as  to  be  scarcely  deserving  of  notice.  The  patient 
has  returned  to  her  household  duties,  and,  in  favourable 
weather,  walks  daily  in  the  open  air ; in  fact,  with  the 
exception  of  a little  weakness  and  irritability,  which, 
however,  were  always  peculiar  to  her,  she  is  in  perfect 
health.  Still,  for  security’s  sake,  I have  advised  her  to 
continue  inhaling. 


API^ENDIX. 


153  - 


Case  IL  A female,  21  years  of  age,  healthy  from 
childhood,  but  of  consumptive  make — that  is,  neck  long, 
chest  narrow  and  compressed,  skin  white  and  delicate, 
with  rosy  transparent  cheeks,  and  light  brown  hair,  eye- 
brows, and  eye-lashes — contracted,  about  fifteen  months 
since,  a dry,  obstinate  cough  ; in  all  probability,  while 
heated  by  excessive  dancing.  It  was  accompanied  by  a 
pain  in  the  chest ; but  was  entirely  disregarded  by  her, 
until  she  began  to  expectorate,  at  times,  about  half  a cup 
full  of  bright  red,  frothy  blood.  This  sanguineous  ex- 
pectoration was  removed  by  appropriate  medicine  ; and, 
in  the  course  of  the  following  summer,  the  cough,  like- 
wise, was  partially  subdued. 

I was  called  in  to  see  her,  in  the  autumn  of  this  year, 
aggravation  of  the  above  symptoms  having  taken  place, 
and  found  her  in  the  following  condition  : her  rosy  com- 
plexion gone  ; pallid,  much  emaciated,  strength  greatly 
impaired ; chest  contracted  and  sinking  in,  respiration 
quick  and  short,  a rattle  during  each  inspiration,  particu- 
larly marked  in  the  right  lung,  where  a cavernous  sound 
was  yielded  on  percussion  ; a sense  of  pain  in  the  same 
spot  with  occasional  twitchings  over  the  chest ; frequent 
cough,  partly  dry,  and  in  part  accompanied  by  a yel- 
lowish green  expectoration,  which,  in  the  course  of  the 
four  and  twenty  hours,  might  have  filled  a good  sized 
cup.  Her  appetite  was  small,  sleep  short  and  interrupt- 
ed by  frequent  cough,  pulse  quick  ; toward  morning  she 
fell  into  profuse  perspirations,  and  fits  of  shivering  at 
noon,  and  toward  evening  there  came  on  a dry,  burning 
heat,  with  hot  hands,  flushing  of  one  cheek  in  particular, 
and  extreme  thirst ; there  was  oedema  of  both  feet,  and 
menstruation  had  ceased  for  three  months. 

Under  these  circumstances,  I ordered  eight  leeches  to 
be  applied  to  the  right  side  of  the  chest : but  no  relief 
being  afforded  to  the  painful  sensations  there,  I had  six 
ounces  of  blood  taken  from  the  right  arm  a few  days 
after.  At  the  same  time,  the  patient  commenced  in- 
haling, taking  no  medicine,  but  observing  a suitable 
regimen.  The  progress  of  the  patient  soon  convinced 
me  of  the  good  effect  of  this  method ; and  she  herself 
was  much  cheered  by  her  sleep  being  sounder  and  less 
broken  by  coughing.  This  amendment  continued  unin- 
terruptedly, so  that  in  the  space  of  six  weeks  the  cough 

20 


154 


APPENDIX. 


and  expectoration  had  decreased  to  such  an  extent  that 
the  latter  amounted  in  the  four  and  twenty  hours  to  no 
more  than  about  half  a table-spoonful.  At  the  same 
time,  the  pain  in  the  chest  had  disappeared,  the  rattle 
spoken  of  above  was  no  longer  audible,  the  perspira- 
tions, shiverings,  and  swelling  of  the  feet  had  left  her, 
her  appetite  had  returned  ; and  what  with  the  refreshing 
nature  of  her  sleep,  the  increase  of  her  strength,  and  the 
amendment  in  her  respiration,  the  patient  was  so  much 
recovered  as  to  be  able  to  take  half  an  hours  walk  every 
day  in  the  open  air.  Still  the  sensation  of  heat  toward 
evening,  the  flushing  of  the  one  cheek,  the*  frequent 
pulse,  and  the  fact  of  the  patient’s  not  increasing  visibly 
in  bulk,  overcast  the  prospect  of  perfect  recovery. 

After  these  favourable  symptoms  had  lasted  about  a 
week,  the  patient  was  persuaded  to  take  a ride  with  a 
friend  when  it  blew  a cold  east  wind.  The  consequence 
was  that  in  the  evening  of  this  day  she  was  sensible  of 
cold  in  the  head,  hoarseness,  pain  in  the  throat,  and  in- 
creased cough.  Relying  on  the  happy  results  which 
Dr.  Ramadge  has  observed  to  attend  the  supervention 
of  catarrh,  I ordered  the  inhalation  to  be  discontinued, 
and  patiently  awaited  the  issue.  But  I was  soon  con- 
scious of  the  disappointment  of  my  hopes  ; for  notwith- 
standing the  patient  got  rid  in  a few  days  of  the  cold  in 
the  head,  the  hoarseness,  and  the  pain  in  the  throat,  yet 
the  earlier  symptom  of  pain  in  the  chest  returned  with 
more  than  its  former  violence.  She  now  also  felt  a 
pain  in  the  left  side,  in  the  neighbourhood  of  the  fourth 
rib ; her  respiration  grew  shorter,  her  cough  became 
worse,  the  expectoration  increased  to  its  first  amount, 
the  nightly  perspirations  returned,  the  feet  swelled,  and 
altogether  her  state  of  health  was  worse  than  it  had 
been  when  I first  saw  her. 

I now  recurred  to  the  inhalation  ; and  again  the  re- 
sults were  so  favourable  that  the  cough  and  expectora- 
tion decreased,  but  not  to  the  degree  that  had  taken  place 
previously  to  the  relapse. 

The  unfavourable  symptoms  before  described  again 
made  their  appearance,  and  the  patient  soon  afterward 
died  in  a violent  fit  of  suffocation. 

Although  it  is  doubtful  whether  inhalation  would  have 
effected  a cure  in  this  case,  in  which  pulmonary  con- 


APPENDIX. 


155 


sumption  had  already  made  such  considerable  progress, 
I can  scarcely  doubt  that  it  would  have  proved  success- 
ful had  it  been  adopted  at  an  earlier  stage.  The  patient 
■was  loud  in  her  praise  of  its  beneficial  effects,  and  I have 
no  reason  to  dissent  from  her,  as  I am  firmly  persuaded 
that  I should  not  have  affected  more,  but  most  probably 
much  less  with  other  remedies. 

It  was  discovered  by  dissection  that  the  immediate 
cause  of  death  was  rather  effusion  within  the  cavity  of 
the  chest  than  extensive  suppuration. 


There  is  one  point  in  the  above  case  which  requires 
notice.  Dr.  Hohnbaum  was  correct  in  his  general  prin- 
ciple when  he  concluded  that  the  ingression  of  catarrh 
on  phthisis  was  a favourable  symptom,  but  wrong  in  its 
application  to  this  particular  instance.  The  disease 
was  so  far  advanced  that  he  should  not  have  intermitted 
the  inhalation,  and  trusted,  as  he  did,  to  the  beneficial 
influence  of  the  catarrh  solely.  Indeed,  as  I have 
already  observed,  the  process  of  inhalation  will  not  only 
effect  thoroughly  what  nature,  by  means  of  catarrh,  too 
often  brings  about  imperfectly,  but  will  obviate  the 
emphysematous  state  which  is  entailed  by  the  catarrh. 

The  following  letter  has  this  moment  reached  me. 
It  is  in  every  way  too  gratifying  for  rne  to  hesitate  to 
publish  it.  By  so  doing  I shall  best  fulfil  the  writer’s 
intention,  and  shall  be  enabled  to  prove  to  the  most 
skeptical  the  positive  powers  of  inhalation.  The 
hypercritical  may  refuse  to  admit  assertions  as  to  the 
changes  which  pass  inside  the  chest,  but  can  hardly 
withhold  credence  from  those  proved  by  measurement 
to  take  place  outside. 


Tenby,  26th  Oct.  1834. 

Dear  Sir, 

I trust  you  will  be  pleased  to  hear  of  the  suc- 
cess of  a course  of  six  months’  inhalation  in  my  case. 

In  order  to  bring  to  your  recollection  the  circumstances 
under  which  I waited  upon  you  for  advice,  I beg  to  re- 
fer you  to  your  note  book,  in  v/hich,  if  I recollect  aright, 


156 


APPENDIX. 


you  will  find  the  29th  of  last  March  specified  as  the 
date  of  my  first  visit.  But  as  you  may  have  kept  no 
memorandum,  I may  remind  you  that  mine  was  a case 
of  sinking  in  of  the  sternum  so  as  to  press  on  the  right 
ventricle  of  the  heart ; you  likewise  described  the  arch 
as  being  under  compression,  and  the  ribs  fixed.  The 
attendant  symptoms  I need  not  detail. 

I commenced  inhaling  on  the  30th  of  March.  You 
directed  me  to  inhale  three  times  a day ; but  being  under 
great  suffering  at  night  when  I assumed  a reclining  pos- 
ture, I thought  it  desirable  to  inhale  four  times  daily, 
which  I followed  up  for  the  first  four  months.  Finding 
myself  greatly  relieved  at  the  expiration  of  this  period, 
I have  inhaled  for  the  last  two  months  only  three  times 
a day.  It  was  not  until  the  22nd  of  April  that  I could 
manage  to  inhale  continuously  half  an  hour  at  a time  ; 
and  on  that  day  my  girth  was  taken  immediately  under 
the  nipples  of  the  breast  by  Mr.  Shaw,  our  medical  at- 
tendant. 


May  22d,  Increase  the  1st  month,  five-eighths  of  an  inch. 
June  22d, 

July  22d, 

Aug.  22d, 

Sept.  22d, 

Oct.  22, 

Whole  increase,  two  and  a half  inches. 


a 

2d  “ 

three-eighths 

i( 

3d  “ 

one-half 

a 

4th  “ 

three-eighths 

u 

5th  “ 

one-fourth 

u 

6 th  “ 

three-eighths 

In  the  first  measurement  my  girth  was  two  feet  ten 
and  a half  inches. 

October  22d  it  was  three  feet  and  one  inch. 

In  June  I took  six  inspirations  and  six  expirations 
per  minute  while  inhaling.  In  August  I took  only  five 
inspirations  and  five  expirations  during  the  same  time. 
This  month  I have  taken  only  five  inspirations  and  four 
expirations  or  the  reverse — showing,  I presume,  the  in- 
creased volume  of  the  lungs. 

This  increase  is,  I think,  great  at  my  time  of  life,  as 
I am  forty-six  years  of  age.  The  benefit  I have  derived 
is  necessarily  very  great.  My  ribs,  judging  from  the 
heaving  of  my  breast  when  I breathe,  have,  I should 
conclude,  come  into  tolerable  play.  My  lungs  are 
amazingly  strengthened  : I can  now  sing  at  the  very 


APPENDIX. 


157 


top  of  my  voice,  but  not  long  together.  I sleep  in  gen- 
eral well,  but  I am  not  able  to  lie  on  my  left  side.  The 
sinking  of  the  sternum,  however,  remains  exactly  the 
same,  and  occasionally  my  pulse  intermits — generally 
whenever  I stoop  to  do  any  thing.  Nevertheless,  I can 
walk  at  a great  rate  without  inconvenience,  and  do  walk 
from  three  to  five  miles  every  day.  I have  gained  con- 
siderable fiesh,  and  my  appetite  is  always  good. 

I do  not  hesitate  to  say  that  I think  inhaling  has  done 
me  more  good  than  all  the  Uue  pills  I ever  took  for 
bilious  attacks. 

If  this  communication  will  tend  to  illustrate  any  point 
of  practice,  you  are  quite  at  liberty  to  use  my  name  and 
reference. 

I am  happy  also  to  inform  you  that  Mr.  Shaw  has 
made  a cure  of  consumption  in  this  neighbourhood  by 
following  your  system.  I visited  the  individual  when 
he  was  thought  to  be  in  a dying  state,  and  he  is  now 
about  pursuing  his  usual  avocations. 

I remain,  dear  Sir, 

Your  obliged, 

J.  Greaves. 


The  following  statement  is  copied  from  the  Royal  Kalender,  and 
Court  and  City  Register  for  England,  Scotland,  Ireland,  and  the 
Colonies,  for  the  Year  1839. 

Infirmary  for  Asthma^  Consumption,  and  other  Diseases  of  the  Lungs, 
10  Artillery-street,  Bishopsgate, 

President,  Duke  of  Sussex. 

Vice  Presidents,  Marquis  Camden,  Marquis  of  Hertfrod, 
Marquis  of  Anglesey,  Earl  of  Ripon,  Lord  Calthorpe, 
Lord  Ellenborough. 

Treasurer, 

Physicians,  F.  H.  Ramadge,  M.  D.,  Thos.  Davies,  M.  D. 
Apothecary,  Mr.  William  Herring. 

Honorary  Sec.,  Samuel  Amory,  Esq. 

Assist.  Sec.  and  Collector,  Mr.  Wm.  Eddrup,  51  Houndsditch. 
Matron,  Mrs.  Jane  Hine. 


The  following  explanations  of  some  of  the  medical  terms 

EMPLOYED  IN  THIS  WORK  MAY  BE  OF  USE  TO  THE  GENERAL  READER. 

Abscess, — A cavity  containing  purulent  matter  produced  by  suppuration. 

Aorta, — The  great  artery  of  the  body  which  arises  from  the  left  ven- 
tricle of  the  heart,  forms  a curvature  in  the  chest,  and  descends  into 
the  abdomen. 

Anfractuous, — Winding,  full  of  windings  and  turnings. 

Aphony, — A loss  of  voice, 

Amenorrhcea, — Suppression  of  the  menses. 

Arteries, — Vessels  originating  from  the  heart.  By  their  means  the 
blood  is  carried  to  every  part  of  tbe  body  for  nutrition,  &c.  The 
action  of  the  arteries,  called  the  pulse,  corresponds  to  that  of  the 
heart. 

Arterial, — Belonging  to  the  arteries. 

Auricles, — Those  portions  of  the  heart  that  receive  the  blood  from  the 
veins. 

Autopsis, — An  examination  after  death,  post  mortem. 

Aspera  arteria, — The  trachea,  or  windpipe. 

Astringent, — Binding,  contracting,  opposed  to  laxative. 

Auscultation, — A method  of  distinguishing  diseases,  particularly  in  the 
thorax,  by  observing  the  sounds  in  the  part,  generally  by  means  of  a 
tube  applied  to  the  surface. 

Bronchii, — The  ramifications  of  the  trachea. 

Bronchial, — Belonging  to  the  bronchia,  or  ramifications  of  the  wind- 
pipe  in  the  lungs. 

Calcareous, — Containing  lime. 

Cava, — Hollow. 

Catarrh, — A deduction  of  mucus  from  the  membranes  of  the  nose, 
fauces,  and  bronchiae  • 

Cervix, — Neck. 

Cartilage, — Gristle,  a smooth,  solid,  elastic  substance,  softer  than  bone. 

Colliquative, — Wasting,  indicating  a morbid  discharge  of  animal  fiuids. 

Cellular, — Consisting  of  cells,  or  containing  cells. 

Cicatrize, — To  heal  or  be  healed,  to  skin  over  by  a scar. 

Coalesce, — To  grow  together,  to  unite,  as  separate  bodies. 

Collapse, — A falling,  sinking,  a low  and  feeble  condition. 

Congestion, — A collection  of  fluids  in  an  animal  body,  an  accumulation 
of  blood  in  a part. 

Conjunctiva, — The  exterior  covering  of  the  eye,  and  inner  parts  of 
the  eyelids. 

Cuticle, — The  scarf  skin. 

Clavicula, — The  clavicle,  or  collar  bone. 

Clavicles, — The  collar  bones. 

Dyspnoea, — Difficulty  of  breathing. 

Demulcent, — Softening,  mollifying,  mucilaginous. 

Depletion, — The  act  of  diminishing  the  quantity  of  blood,  usually  by 
the  lancet. 

Diaphragm, — The  muscular  partition  between  the  chest  and  abdomen. 

Dilatation, — The  act  of  expanding,  expansion. 


EXPLANATION  OF  MEDICAL  TERMS.  159 

Diagnostic, — The  sign  or  symptom  by  which  a disease  is  known  or 
distinguished  from  others. 

Effusions, — Fluids  generally  colourless  secreted  into  cavities  where 
they  do  not  belong. 

Eliminations, — Animal  products  thrown  off  or  expelled  from  the  system. 

Emphysema, — A distention  of  cells  in  any  part  of  the  body,  particu- 
larly the  lungs,  by  air  or  gas. 

Epispastics, — Blisters. 

Encysted, — Enclosed  in  a body,  bladder  or  vesicle. 

Eschar^ — ^The  crust  or  scab  occasioned  by  burns  or  caustic  applica- 
tions. 

Febrile^ — Feverish. 

Fibre, — A fine  slender  body  or  thread  which  is  a constituent  part  of 
muscles. 

Fistula, — A deep  narrow  ulcer. 

Gland,— A soft  body  formed  by  the  union  of  a great  number  of  vessels 
for  the  production  of  the  various  animal  secretions. 

Granule, — A grain,  a small  particle. 

Generic, — Pertaining  to  a genus  or  kind. 

Gelatinous, — Resembling  jelly. 

Gangrene, — The  first  stage  of  mortification. 

Hemoptesis, — A spitting  of  blood. 

Hepatization, — A consolidation,  as  when  the  lungs  assume  a consoli. 
dated  form  like  liver. 

Hypertrophy, — A morbid  increase  in  the  size  and  weight  of  any  organ, 
as  the  heart. 

Induration, — The  act  of  hardening. 

Interstitial, — Implying  spaces  between  the  constituent  parts  of  any 
organ. 

Infiltration, — A passing  of  liquids  into  portions  of  the  body  where  they 
do  not  belong. 

Lamina, — Scales  or  plates.  It  is  used  to  express  the  foliated  structure 
of  bones  or  other  organs. 

Lamellar, — Disposed  in  thin  plates  or  scales. 

Larynx, — The  upper  part  of  the  windpipe. 

Laryngeal, — Pertaining  to  the  larynx. 

Lobe, — A part  or  division  of  the  lungs. 

Lymphatics, — Vessels  which  convey  only  colourless  fluids,  as  lymph. 

Marasmus, — A wasting  of  flesh  without  fever,  or  apparent  disease,  a 
kind  of  consumption. 

Membrane, — A thin  expansion  very  much  resembling  the  skin  in  its 
structure  and  appearance,  and  constituting  the  inner  lining  of  the 
lungs,  stomach,  bowels,  &.c. 

Mucous  membrane, — The  membrane  lining  the  alimentary  canal, 
lungs,  dec. 

Morbid, — D isea  sed . 

Mucilage, — A solution  of  gum. 

Mucilaginous, — Pertaining  to  mucilage. 

Nodule, — A little  knot  or  lump. 

Narcotics, — Drugs  causing  stupour,  stupefaction. 

(Edematous, — Puffy,  retaining  the  impression  of  the  fingers. 

Pancreas, — A gland  of  the  body  situated  between  the  bottom  of  the 
stomach  and  the  spine. 


160 


EXPLANATION  OF  MEDICAL  TERMS. 


Pathology^ — That  part  of  medicine  which  explains  the  nature  of  dis- 
eases, causes,  and  symptoms. 

Parietes, — The  fleshy  walls  that  enclose  a cavity. 

Paroxysm^ — A temporary  increase  or  aggravation  of  disease. 

Parenchymatous^ — Pertaining  to  the  solid  parts  of  glands  as  distin- 
guished  from  the  superficial  or  membranous  coverings. 

Pericardium^ — A membrane  surrounding  the  heart. 

Pectoriloquism^ — TJie  act  of  transmitting  articulate  sounds  through 
the  walls  of . tlie'^hest. 

Phthisis, — Disfe'dse  of  the  lungs  occasioned  by  tubercles,  pulmonary 
consumption.,*  • v 

Pleura, — A thin  mumbrane  that  covers  the  inside  of  the  thorax. 

Pleurisy, — Ah  inflammation  of  the  pleura. 

Peripneumony,—An  inflammation  of  the  lungs. 

Pneumonic, — Pertaining  to  the  lungs,  pulmonic. 

Post  mortem, — After  death. 

Prophylactic, — Preventive,  defending  from  disease. 

Pus, — White  or  yellowish  matter  generated  in  ulcers  and  wounds  in 
the  process  of  healing. 

Secretions, — The  act  of  producing  from  the  blood  substances  different 
from  the  blood  itself,  or  from  any  of  its  constituents. 

Spleen, — A soft  grand ular  organ  in  the  left  and  upper  part  of  the  ab- 
domen. 

Sputa, — Things  ejected  or  spit  from  the  mouth. 

Subacute, — Of  a grade  of  action  below  the  highest  or  most  acute 
point. 

Suppuration, — The  morbid  action  by  which  pus  is  deposited  in  inflam- 
matory tumours. 

Supervening, — Coming  in  an  additional  way. 

Sudorijics,  Diaphoretics, — Medicines  causing  sweat,  exciting  perspi- 
ration. 

Stethoscope^ — A tubular  instrument  for  distinguishing  diseases  of  the 
chest  by  sounds. 

Thyroid, — A cartilage  of  the  larynx,  the  pomum  Adami,  or  Adam’s 
apple  in  the  throat.  It  is  larger  in  men  than  in  women. 

Tonics, — Medicines  used  for  increasing  the  strength  or  the  tone  of  the 
animal  system. 

Tissue, — A particular  arrangement  of  nervous  or  muscular  fibres  in 
the  organs. 

Thorax, — The  chest,  that  part  of  the  body  situated  between  the  neck 
and  the  abdomen,  containing  the  lungs,  heart,  pleura,  &;c. 

Trachea, — The  windpipe. 

Vesicle, — A little  bladder  or  a portion  of  the  cuticle  separated  from 
the  skin  and  filled  with  some  humour. 

Ventricle, — A small  cavity  in  an  animal  body. 

Vena  porta, — The  large  vein  that  conveys  the  blood  from  the  abdo- 
minal viscera  to  the  heart. 

Vena  azygos, — A solitary  vein  in  the  right  cavity  of  the  thorax. 

Viscera, — Internal  organs,  as  the  liver,  stomach,  kidneys,  lungs, 
heart,  &c. 

Viscera  abdominal, — The  glands  and  hollow  organs  of  the  abdomen. 


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